Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

FEMORAL HEAD COCR 36MM,3.5MM

Facility

$2,071.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.50
Max. Negotiated Rate	$2,008.87
Rate for Payer: AlohaCare Medicaid	$1,035.50
Rate for Payer: AlohaCare Medicare	$1,573.96
Rate for Payer: Cash Price	$1,242.60
Rate for Payer: Devoted Health Medicare	$1,739.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,573.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,449.70
Rate for Payer: Health Management Network Commercial	$1,760.35
Rate for Payer: Humana Medicare	$1,573.96
Rate for Payer: Kaiser Permanente Commercial	$1,863.90
Rate for Payer: Kaiser Permanente Medicaid	$1,056.21
Rate for Payer: Kaiser Permanente Medicare	$1,573.96
Rate for Payer: MDX Hawaii PPO	$2,008.87
Rate for Payer: Ohana Health Plan Medicaid	$1,573.96
Rate for Payer: Ohana Health Plan Medicare	$1,573.96
Rate for Payer: UnitedHealthcare Medicare	$1,573.96
Rate for Payer: University Health Alliance Commercial	$1,159.76

FEMORAL HEAD COCR 36MM,3.5MM

Facility

$2,071.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,159.76
Max. Negotiated Rate	$2,008.87
Rate for Payer: Cash Price	$1,242.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,449.70
Rate for Payer: Health Management Network Commercial	$1,760.35
Rate for Payer: Kaiser Permanente Commercial	$1,863.90
Rate for Payer: MDX Hawaii PPO	$2,008.87
Rate for Payer: University Health Alliance Commercial	$1,159.76

FEMORAL HEAD LFIT 6260-9-336

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

FEMORAL HEAD LFIT 6260-9-336

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

FEMORAL HEAD LKIT 6260-9-332

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

FEMORAL HEAD LKIT 6260-9-332

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

FEMORAL HEAD UNI 6519-1-036

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

FEMORAL HEAD UNI 6519-1-036

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

FEMORAL INSERT SZ7 1516-20-708

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

FEMORAL INSERT SZ7 1516-20-708

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$2,280.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$2,520.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$2,280.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: Kaiser Permanente Medicare	$2,280.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$2,280.00
Rate for Payer: Ohana Health Plan Medicare	$2,280.00
Rate for Payer: UnitedHealthcare Medicare	$2,280.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

FEMORAL KNEE RT XSMALL 161467

Facility

$4,380.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,452.80
Max. Negotiated Rate	$4,248.60
Rate for Payer: Cash Price	$2,628.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,066.00
Rate for Payer: Health Management Network Commercial	$3,723.00
Rate for Payer: Kaiser Permanente Commercial	$3,942.00
Rate for Payer: MDX Hawaii PPO	$4,248.60
Rate for Payer: University Health Alliance Commercial	$2,452.80

FEMORAL KNEE RT XSMALL 161467

Facility

$4,380.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,190.00
Max. Negotiated Rate	$4,248.60
Rate for Payer: AlohaCare Medicaid	$2,190.00
Rate for Payer: AlohaCare Medicare	$3,328.80
Rate for Payer: Cash Price	$2,628.00
Rate for Payer: Devoted Health Medicare	$3,679.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,328.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,066.00
Rate for Payer: Health Management Network Commercial	$3,723.00
Rate for Payer: Humana Medicare	$3,328.80
Rate for Payer: Kaiser Permanente Commercial	$3,942.00
Rate for Payer: Kaiser Permanente Medicaid	$2,233.80
Rate for Payer: Kaiser Permanente Medicare	$3,328.80
Rate for Payer: MDX Hawaii PPO	$4,248.60
Rate for Payer: Ohana Health Plan Medicaid	$3,328.80
Rate for Payer: Ohana Health Plan Medicare	$3,328.80
Rate for Payer: UnitedHealthcare Medicare	$3,328.80
Rate for Payer: University Health Alliance Commercial	$2,452.80

FEMORAL POST AUGMEN 5544-A-400

Facility

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.28
Max. Negotiated Rate	$2,364.86
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL POST AUGMEN 5544-A-400

Facility

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,219.00
Max. Negotiated Rate	$2,364.86
Rate for Payer: AlohaCare Medicaid	$1,219.00
Rate for Payer: AlohaCare Medicare	$1,852.88
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Devoted Health Medicare	$2,047.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,852.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Humana Medicare	$1,852.88
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: Kaiser Permanente Medicaid	$1,243.38
Rate for Payer: Kaiser Permanente Medicare	$1,852.88
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: Ohana Health Plan Medicaid	$1,852.88
Rate for Payer: Ohana Health Plan Medicare	$1,852.88
Rate for Payer: UnitedHealthcare Medicare	$1,852.88
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL POSTERIOR 5544-A-500

Facility

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,219.00
Max. Negotiated Rate	$2,364.86
Rate for Payer: AlohaCare Medicaid	$1,219.00
Rate for Payer: AlohaCare Medicare	$1,852.88
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Devoted Health Medicare	$2,047.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,852.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Humana Medicare	$1,852.88
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: Kaiser Permanente Medicaid	$1,243.38
Rate for Payer: Kaiser Permanente Medicare	$1,852.88
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: Ohana Health Plan Medicaid	$1,852.88
Rate for Payer: Ohana Health Plan Medicare	$1,852.88
Rate for Payer: UnitedHealthcare Medicare	$1,852.88
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL POSTERIOR 5544-A-500

Facility

$2,438.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.28
Max. Negotiated Rate	$2,364.86
Rate for Payer: Cash Price	$1,462.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,706.60
Rate for Payer: Health Management Network Commercial	$2,072.30
Rate for Payer: Kaiser Permanente Commercial	$2,194.20
Rate for Payer: MDX Hawaii PPO	$2,364.86
Rate for Payer: University Health Alliance Commercial	$1,365.28

FEMORAL POSTERIOR 5 5543-A-500

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.32
Max. Negotiated Rate	$2,252.34
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: University Health Alliance Commercial	$1,300.32

FEMORAL POSTERIOR 5 5543-A-500

Facility

$2,322.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,161.00
Max. Negotiated Rate	$2,252.34
Rate for Payer: AlohaCare Medicaid	$1,161.00
Rate for Payer: AlohaCare Medicare	$1,764.72
Rate for Payer: Cash Price	$1,393.20
Rate for Payer: Devoted Health Medicare	$1,950.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,764.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,625.40
Rate for Payer: Health Management Network Commercial	$1,973.70
Rate for Payer: Humana Medicare	$1,764.72
Rate for Payer: Kaiser Permanente Commercial	$2,089.80
Rate for Payer: Kaiser Permanente Medicaid	$1,184.22
Rate for Payer: Kaiser Permanente Medicare	$1,764.72
Rate for Payer: MDX Hawaii PPO	$2,252.34
Rate for Payer: Ohana Health Plan Medicaid	$1,764.72
Rate for Payer: Ohana Health Plan Medicare	$1,764.72
Rate for Payer: UnitedHealthcare Medicare	$1,764.72
Rate for Payer: University Health Alliance Commercial	$1,300.32

FEMORAL PRECOAT CR-FLEX GSF

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

FEMORAL PRECOAT CR-FLEX GSF

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

FEMORAL SLEEVE 6MM 650-1064

Facility

$563.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$281.50
Max. Negotiated Rate	$546.11
Rate for Payer: AlohaCare Medicaid	$281.50
Rate for Payer: AlohaCare Medicare	$427.88
Rate for Payer: Cash Price	$337.80
Rate for Payer: Devoted Health Medicare	$472.92
Rate for Payer: Hawaii Medical Service Association Medicare	$427.88
Rate for Payer: Hawaii Western Management Group Commercial	$394.10
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Humana Medicare	$427.88
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: Kaiser Permanente Medicaid	$287.13
Rate for Payer: Kaiser Permanente Medicare	$427.88
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: Ohana Health Plan Medicaid	$427.88
Rate for Payer: Ohana Health Plan Medicare	$427.88
Rate for Payer: UnitedHealthcare Medicare	$427.88
Rate for Payer: University Health Alliance Commercial	$315.28

FEMORAL SLEEVE 6MM 650-1064

Facility

$563.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$315.28
Max. Negotiated Rate	$546.11
Rate for Payer: Cash Price	$337.80
Rate for Payer: Hawaii Western Management Group Commercial	$394.10
Rate for Payer: Health Management Network Commercial	$478.55
Rate for Payer: Kaiser Permanente Commercial	$506.70
Rate for Payer: MDX Hawaii PPO	$546.11
Rate for Payer: University Health Alliance Commercial	$315.28

FEMORAL STABILIZER 5512-F-501

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,141.50
Max. Negotiated Rate	$11,914.51
Rate for Payer: AlohaCare Medicaid	$6,141.50
Rate for Payer: AlohaCare Medicare	$9,335.08
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Devoted Health Medicare	$10,317.72
Rate for Payer: Hawaii Medical Service Association Medicare	$9,335.08
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Humana Medicare	$9,335.08
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: Kaiser Permanente Medicaid	$6,264.33
Rate for Payer: Kaiser Permanente Medicare	$9,335.08
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: Ohana Health Plan Medicaid	$9,335.08
Rate for Payer: Ohana Health Plan Medicare	$9,335.08
Rate for Payer: UnitedHealthcare Medicare	$9,335.08
Rate for Payer: University Health Alliance Commercial	$6,878.48

FEMORAL STABILIZER 5512-F-501

Facility

$12,283.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,878.48
Max. Negotiated Rate	$11,914.51
Rate for Payer: Cash Price	$7,369.80
Rate for Payer: Hawaii Western Management Group Commercial	$8,598.10
Rate for Payer: Health Management Network Commercial	$10,440.55
Rate for Payer: Kaiser Permanente Commercial	$11,054.70
Rate for Payer: MDX Hawaii PPO	$11,914.51
Rate for Payer: University Health Alliance Commercial	$6,878.48

FEMORAL STEM #00-7833-012-00

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

Know your out-of-pocket cost for care.

All Charges