Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

FEMORAL STEM #00-7833-012-00

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

FEMORAL SZ3 LEFT PS 5515-F-301

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

FEMORAL SZ3 LEFT PS 5515-F-301

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

FEMORAL SZ#3 RETAIN 5517-F-302

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,993.00
Max. Negotiated Rate	$15,506.42
Rate for Payer: AlohaCare Medicaid	$7,993.00
Rate for Payer: AlohaCare Medicare	$12,149.36
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Devoted Health Medicare	$13,428.24
Rate for Payer: Hawaii Medical Service Association Medicare	$12,149.36
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Humana Medicare	$12,149.36
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: Kaiser Permanente Medicaid	$8,152.86
Rate for Payer: Kaiser Permanente Medicare	$12,149.36
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: Ohana Health Plan Medicaid	$12,149.36
Rate for Payer: Ohana Health Plan Medicare	$12,149.36
Rate for Payer: UnitedHealthcare Medicare	$12,149.36
Rate for Payer: University Health Alliance Commercial	$8,952.16

FEMORAL SZ#3 RETAIN 5517-F-302

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,952.16
Max. Negotiated Rate	$15,506.42
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: University Health Alliance Commercial	$8,952.16

FEMORAL SZ#4 RETAIN 5517-F-402

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,952.16
Max. Negotiated Rate	$15,506.42
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: University Health Alliance Commercial	$8,952.16

FEMORAL SZ#4 RETAIN 5517-F-402

Facility

$15,986.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$7,993.00
Max. Negotiated Rate	$15,506.42
Rate for Payer: AlohaCare Medicaid	$7,993.00
Rate for Payer: AlohaCare Medicare	$12,149.36
Rate for Payer: Cash Price	$9,591.60
Rate for Payer: Devoted Health Medicare	$13,428.24
Rate for Payer: Hawaii Medical Service Association Medicare	$12,149.36
Rate for Payer: Hawaii Western Management Group Commercial	$11,190.20
Rate for Payer: Health Management Network Commercial	$13,588.10
Rate for Payer: Humana Medicare	$12,149.36
Rate for Payer: Kaiser Permanente Commercial	$14,387.40
Rate for Payer: Kaiser Permanente Medicaid	$8,152.86
Rate for Payer: Kaiser Permanente Medicare	$12,149.36
Rate for Payer: MDX Hawaii PPO	$15,506.42
Rate for Payer: Ohana Health Plan Medicaid	$12,149.36
Rate for Payer: Ohana Health Plan Medicare	$12,149.36
Rate for Payer: UnitedHealthcare Medicare	$12,149.36
Rate for Payer: University Health Alliance Commercial	$8,952.16

FEMORAL SZ5 LEFT PS 5515-F-501

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

FEMORAL SZ5 LEFT PS 5515-F-501

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

FEMORAL SZ5 RIGHT 5516-F-502

Facility

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$8,076.00
Max. Negotiated Rate	$15,667.44
Rate for Payer: AlohaCare Medicaid	$8,076.00
Rate for Payer: AlohaCare Medicare	$12,275.52
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Devoted Health Medicare	$13,567.68
Rate for Payer: Hawaii Medical Service Association Medicare	$12,275.52
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: Humana Medicare	$12,275.52
Rate for Payer: Kaiser Permanente Commercial	$14,536.80
Rate for Payer: Kaiser Permanente Medicaid	$8,237.52
Rate for Payer: Kaiser Permanente Medicare	$12,275.52
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: Ohana Health Plan Medicaid	$12,275.52
Rate for Payer: Ohana Health Plan Medicare	$12,275.52
Rate for Payer: UnitedHealthcare Medicare	$12,275.52
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL SZ5 RIGHT 5516-F-502

Facility

$16,152.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$9,045.12
Max. Negotiated Rate	$15,667.44
Rate for Payer: Cash Price	$9,691.20
Rate for Payer: Hawaii Western Management Group Commercial	$11,306.40
Rate for Payer: Health Management Network Commercial	$13,729.20
Rate for Payer: Kaiser Permanente Commercial	$14,536.80
Rate for Payer: MDX Hawaii PPO	$15,667.44
Rate for Payer: University Health Alliance Commercial	$9,045.12

FEMORAL SZ#6 RETAIN 5517-F-601

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

FEMORAL SZ#6 RETAIN 5517-F-601

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

FEMORAL SZ#7 RETAIN 5517-F-702

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

FEMORAL SZ#7 RETAIN 5517-F-702

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

FEMORAL SZ7 TRIATH 5515-F-702

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

FEMORAL SZ7 TRIATH 5515-F-702

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

FEMORAL SZ8 LEFT PS 5515-F-801

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

FEMORAL SZ8 LEFT PS 5515-F-801

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

FEMORAL TRIATHLON #5510-F-401

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

FEMORAL TRIATHLON #5510-F-401

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

FEMORAL TRIATH SZ#7 5515-F-701

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

FEMORAL TRIATH SZ#7 5515-F-701

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

FEMORAL TT CR FSZ4 5517-F-401

Facility

$5,887.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,943.50
Max. Negotiated Rate	$5,710.39
Rate for Payer: AlohaCare Medicaid	$2,943.50
Rate for Payer: AlohaCare Medicare	$4,474.12
Rate for Payer: Cash Price	$3,532.20
Rate for Payer: Devoted Health Medicare	$4,945.08
Rate for Payer: Hawaii Medical Service Association Medicare	$4,474.12
Rate for Payer: Hawaii Western Management Group Commercial	$4,120.90
Rate for Payer: Health Management Network Commercial	$5,003.95
Rate for Payer: Humana Medicare	$4,474.12
Rate for Payer: Kaiser Permanente Commercial	$5,298.30
Rate for Payer: Kaiser Permanente Medicaid	$3,002.37
Rate for Payer: Kaiser Permanente Medicare	$4,474.12
Rate for Payer: MDX Hawaii PPO	$5,710.39
Rate for Payer: Ohana Health Plan Medicaid	$4,474.12
Rate for Payer: Ohana Health Plan Medicare	$4,474.12
Rate for Payer: UnitedHealthcare Medicare	$4,474.12
Rate for Payer: University Health Alliance Commercial	$3,296.72

FEMORAL TT CR FSZ4 5517-F-401

Facility

$5,887.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,296.72
Max. Negotiated Rate	$5,710.39
Rate for Payer: Cash Price	$3,532.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,120.90
Rate for Payer: Health Management Network Commercial	$5,003.95
Rate for Payer: Kaiser Permanente Commercial	$5,298.30
Rate for Payer: MDX Hawaii PPO	$5,710.39
Rate for Payer: University Health Alliance Commercial	$3,296.72

Know your out-of-pocket cost for care.

All Charges