Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

C-TPR FEM HEAD 36/+10 06-3610

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Kaiser Permanente Commercial	$4,374.00
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/+2.5 06-3625

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,430.00
Max. Negotiated Rate	$4,714.20
Rate for Payer: AlohaCare Medicaid	$2,430.00
Rate for Payer: AlohaCare Medicare	$3,693.60
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Devoted Health Medicare	$4,082.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,693.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Humana Medicare	$3,693.60
Rate for Payer: Kaiser Permanente Commercial	$4,374.00
Rate for Payer: Kaiser Permanente Medicaid	$2,478.60
Rate for Payer: Kaiser Permanente Medicare	$3,693.60
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: Ohana Health Plan Medicaid	$3,693.60
Rate for Payer: Ohana Health Plan Medicare	$3,693.60
Rate for Payer: UnitedHealthcare Medicare	$3,693.60
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/+2.5 06-3625

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Kaiser Permanente Commercial	$4,374.00
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/-2.5 06-3697

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-TPR FEM HEAD 36/-2.5 06-3697

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-TPR FEM HEAD 36/+5 06-3605

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-TPR FEM HEAD 36/+5 06-3605

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-TPR FEM HEAD 36/+5 18-3605

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-TPR FEM HEAD 36/+5 18-3605

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-TPR FEM HEAD 36/+7.5 06-3675

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,430.00
Max. Negotiated Rate	$4,714.20
Rate for Payer: AlohaCare Medicaid	$2,430.00
Rate for Payer: AlohaCare Medicare	$3,693.60
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Devoted Health Medicare	$4,082.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,693.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Humana Medicare	$3,693.60
Rate for Payer: Kaiser Permanente Commercial	$4,374.00
Rate for Payer: Kaiser Permanente Medicaid	$2,478.60
Rate for Payer: Kaiser Permanente Medicare	$3,693.60
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: Ohana Health Plan Medicaid	$3,693.60
Rate for Payer: Ohana Health Plan Medicare	$3,693.60
Rate for Payer: UnitedHealthcare Medicare	$3,693.60
Rate for Payer: University Health Alliance Commercial	$2,721.60

C-TPR FEM HEAD 36/+7.5 06-3675

Facility

$4,860.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,721.60
Max. Negotiated Rate	$4,714.20
Rate for Payer: Cash Price	$2,916.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,402.00
Rate for Payer: Health Management Network Commercial	$4,131.00
Rate for Payer: Kaiser Permanente Commercial	$4,374.00
Rate for Payer: MDX Hawaii PPO	$4,714.20
Rate for Payer: University Health Alliance Commercial	$2,721.60

CUFF CONTR 18X4.5 60797510300

Facility

$111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$94.35
Max. Negotiated Rate	$107.67
Rate for Payer: Cash Price	$66.60
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: MDX Hawaii PPO	$107.67

CUFF CONTR 18X4.5 60797510300

Facility

$111.00

Hospital Revenue Code	272
Min. Negotiated Rate	$55.50
Max. Negotiated Rate	$107.67
Rate for Payer: AlohaCare Medicaid	$55.50
Rate for Payer: AlohaCare Medicare	$84.36
Rate for Payer: Cash Price	$66.60
Rate for Payer: Devoted Health Medicare	$93.24
Rate for Payer: Hawaii Medical Service Association Medicare	$84.36
Rate for Payer: Hawaii Western Management Group Commercial	$105.45
Rate for Payer: Health Management Network Commercial	$94.35
Rate for Payer: Humana Medicare	$84.36
Rate for Payer: Kaiser Permanente Commercial	$99.90
Rate for Payer: Kaiser Permanente Medicaid	$56.61
Rate for Payer: Kaiser Permanente Medicare	$84.36
Rate for Payer: MDX Hawaii PPO	$107.67
Rate for Payer: Ohana Health Plan Medicaid	$84.36
Rate for Payer: Ohana Health Plan Medicare	$84.36
Rate for Payer: UnitedHealthcare Medicare	$84.36
Rate for Payer: University Health Alliance Commercial	$80.91

CUFF FGS 3.5CM INHIIZONE

Facility

$14,652.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$7,326.00
Max. Negotiated Rate	$14,212.44
Rate for Payer: AlohaCare Medicaid	$7,326.00
Rate for Payer: AlohaCare Medicare	$11,135.52
Rate for Payer: Cash Price	$8,791.20
Rate for Payer: Devoted Health Medicare	$12,307.68
Rate for Payer: Hawaii Medical Service Association Medicare	$11,135.52
Rate for Payer: Hawaii Western Management Group Commercial	$10,256.40
Rate for Payer: Health Management Network Commercial	$12,454.20
Rate for Payer: Humana Medicare	$11,135.52
Rate for Payer: Kaiser Permanente Commercial	$13,186.80
Rate for Payer: Kaiser Permanente Medicaid	$7,472.52
Rate for Payer: Kaiser Permanente Medicare	$11,135.52
Rate for Payer: MDX Hawaii PPO	$14,212.44
Rate for Payer: Ohana Health Plan Medicaid	$11,135.52
Rate for Payer: Ohana Health Plan Medicare	$11,135.52
Rate for Payer: UnitedHealthcare Medicare	$11,135.52
Rate for Payer: University Health Alliance Commercial	$8,205.12

CUFF FGS 3.5CM INHIIZONE

Facility

$14,652.00

Service Code	HCPCS C1815
Hospital Revenue Code	278
Min. Negotiated Rate	$8,205.12
Max. Negotiated Rate	$14,212.44
Rate for Payer: Cash Price	$8,791.20
Rate for Payer: Hawaii Western Management Group Commercial	$10,256.40
Rate for Payer: Health Management Network Commercial	$12,454.20
Rate for Payer: Kaiser Permanente Commercial	$13,186.80
Rate for Payer: MDX Hawaii PPO	$14,212.44
Rate for Payer: University Health Alliance Commercial	$8,205.12

CUP FUSION 7HOLE 14MM FC07

Facility

$2,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.00
Max. Negotiated Rate	$2,696.60
Rate for Payer: AlohaCare Medicaid	$1,390.00
Rate for Payer: AlohaCare Medicare	$2,112.80
Rate for Payer: Cash Price	$1,668.00
Rate for Payer: Devoted Health Medicare	$2,335.20
Rate for Payer: Hawaii Medical Service Association Medicare	$2,112.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,946.00
Rate for Payer: Health Management Network Commercial	$2,363.00
Rate for Payer: Humana Medicare	$2,112.80
Rate for Payer: Kaiser Permanente Commercial	$2,502.00
Rate for Payer: Kaiser Permanente Medicaid	$1,417.80
Rate for Payer: Kaiser Permanente Medicare	$2,112.80
Rate for Payer: MDX Hawaii PPO	$2,696.60
Rate for Payer: Ohana Health Plan Medicaid	$2,112.80
Rate for Payer: Ohana Health Plan Medicare	$2,112.80
Rate for Payer: UnitedHealthcare Medicare	$2,112.80
Rate for Payer: University Health Alliance Commercial	$1,556.80

CUP FUSION 7HOLE 14MM FC07

Facility

$2,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,556.80
Max. Negotiated Rate	$2,696.60
Rate for Payer: Cash Price	$1,668.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,946.00
Rate for Payer: Health Management Network Commercial	$2,363.00
Rate for Payer: Kaiser Permanente Commercial	$2,502.00
Rate for Payer: MDX Hawaii PPO	$2,696.60
Rate for Payer: University Health Alliance Commercial	$1,556.80

CUP HUMERAL 32X4MM 5570-3204

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$3,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

CUP HUMERAL 32X4MM 5570-3204

Facility

$4,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

CUP SUTURE 36 AR-9502F-36CPC

Facility

$3,570.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,785.00
Max. Negotiated Rate	$3,462.90
Rate for Payer: AlohaCare Medicaid	$1,785.00
Rate for Payer: AlohaCare Medicare	$2,713.20
Rate for Payer: Cash Price	$2,142.00
Rate for Payer: Devoted Health Medicare	$2,998.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,713.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,499.00
Rate for Payer: Health Management Network Commercial	$3,034.50
Rate for Payer: Humana Medicare	$2,713.20
Rate for Payer: Kaiser Permanente Commercial	$3,213.00
Rate for Payer: Kaiser Permanente Medicaid	$1,820.70
Rate for Payer: Kaiser Permanente Medicare	$2,713.20
Rate for Payer: MDX Hawaii PPO	$3,462.90
Rate for Payer: Ohana Health Plan Medicaid	$2,713.20
Rate for Payer: Ohana Health Plan Medicare	$2,713.20
Rate for Payer: UnitedHealthcare Medicare	$2,713.20
Rate for Payer: University Health Alliance Commercial	$1,999.20

CUP SUTURE 36 AR-9502F-36CPC

Facility

$3,570.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,999.20
Max. Negotiated Rate	$3,462.90
Rate for Payer: Cash Price	$2,142.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,499.00
Rate for Payer: Health Management Network Commercial	$3,034.50
Rate for Payer: Kaiser Permanente Commercial	$3,213.00
Rate for Payer: MDX Hawaii PPO	$3,462.90
Rate for Payer: University Health Alliance Commercial	$1,999.20

CUTTER KNOT PUSHER #AR-4515

Facility

$492.00

Hospital Revenue Code	272
Min. Negotiated Rate	$418.20
Max. Negotiated Rate	$477.24
Rate for Payer: Cash Price	$295.20
Rate for Payer: Health Management Network Commercial	$418.20
Rate for Payer: Kaiser Permanente Commercial	$442.80
Rate for Payer: MDX Hawaii PPO	$477.24

CUTTER KNOT PUSHER #AR-4515

Facility

$492.00

Hospital Revenue Code	272
Min. Negotiated Rate	$246.00
Max. Negotiated Rate	$477.24
Rate for Payer: AlohaCare Medicaid	$246.00
Rate for Payer: AlohaCare Medicare	$373.92
Rate for Payer: Cash Price	$295.20
Rate for Payer: Devoted Health Medicare	$413.28
Rate for Payer: Hawaii Medical Service Association Medicare	$373.92
Rate for Payer: Hawaii Western Management Group Commercial	$467.40
Rate for Payer: Health Management Network Commercial	$418.20
Rate for Payer: Humana Medicare	$373.92
Rate for Payer: Kaiser Permanente Commercial	$442.80
Rate for Payer: Kaiser Permanente Medicaid	$250.92
Rate for Payer: Kaiser Permanente Medicare	$373.92
Rate for Payer: MDX Hawaii PPO	$477.24
Rate for Payer: Ohana Health Plan Medicaid	$373.92
Rate for Payer: Ohana Health Plan Medicare	$373.92
Rate for Payer: UnitedHealthcare Medicare	$373.92
Rate for Payer: University Health Alliance Commercial	$358.62

CUTTER SUTURE TENSION AR-5815

Facility

$656.00

Hospital Revenue Code	272
Min. Negotiated Rate	$328.00
Max. Negotiated Rate	$636.32
Rate for Payer: AlohaCare Medicaid	$328.00
Rate for Payer: AlohaCare Medicare	$498.56
Rate for Payer: Cash Price	$393.60
Rate for Payer: Devoted Health Medicare	$551.04
Rate for Payer: Hawaii Medical Service Association Medicare	$498.56
Rate for Payer: Hawaii Western Management Group Commercial	$623.20
Rate for Payer: Health Management Network Commercial	$557.60
Rate for Payer: Humana Medicare	$498.56
Rate for Payer: Kaiser Permanente Commercial	$590.40
Rate for Payer: Kaiser Permanente Medicaid	$334.56
Rate for Payer: Kaiser Permanente Medicare	$498.56
Rate for Payer: MDX Hawaii PPO	$636.32
Rate for Payer: Ohana Health Plan Medicaid	$498.56
Rate for Payer: Ohana Health Plan Medicare	$498.56
Rate for Payer: UnitedHealthcare Medicare	$498.56
Rate for Payer: University Health Alliance Commercial	$478.16

CUTTER SUTURE TENSION AR-5815

Facility

$656.00

Hospital Revenue Code	272
Min. Negotiated Rate	$557.60
Max. Negotiated Rate	$636.32
Rate for Payer: Cash Price	$393.60
Rate for Payer: Health Management Network Commercial	$557.60
Rate for Payer: Kaiser Permanente Commercial	$590.40
Rate for Payer: MDX Hawaii PPO	$636.32

Know your out-of-pocket cost for care.

All Charges