Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

ANATOMIC ADAPTER 5120-00-110

Facility

$2,246.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,123.00
Max. Negotiated Rate	$2,178.62
Rate for Payer: AlohaCare Medicaid	$1,123.00
Rate for Payer: AlohaCare Medicare	$1,706.96
Rate for Payer: Cash Price	$1,347.60
Rate for Payer: Devoted Health Medicare	$1,886.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,706.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,572.20
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Humana Medicare	$1,706.96
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: Kaiser Permanente Medicaid	$1,145.46
Rate for Payer: Kaiser Permanente Medicare	$1,706.96
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: Ohana Health Plan Medicaid	$1,706.96
Rate for Payer: Ohana Health Plan Medicare	$1,706.96
Rate for Payer: UnitedHealthcare Medicare	$1,706.96
Rate for Payer: University Health Alliance Commercial	$1,257.76

ANATOMIC ADAPTER 5120-00-110

Facility

$2,246.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,257.76
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,347.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,572.20
Rate for Payer: Health Management Network Commercial	$1,909.10
Rate for Payer: Kaiser Permanente Commercial	$2,021.40
Rate for Payer: MDX Hawaii PPO	$2,178.62
Rate for Payer: University Health Alliance Commercial	$1,257.76

ANATOMICAL SHOULDER HUMERAL

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,576.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

ANATOMICAL SHOULDER HUMERAL

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,300.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: AlohaCare Medicaid	$2,300.00
Rate for Payer: AlohaCare Medicare	$3,496.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Devoted Health Medicare	$3,864.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,496.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Humana Medicare	$3,496.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: Kaiser Permanente Medicaid	$2,346.00
Rate for Payer: Kaiser Permanente Medicare	$3,496.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: Ohana Health Plan Medicaid	$3,496.00
Rate for Payer: Ohana Health Plan Medicare	$3,496.00
Rate for Payer: UnitedHealthcare Medicare	$3,496.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

ANATOMICAL SHOULDER REMV HEAD

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,576.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

ANATOMICAL SHOULDER REMV HEAD

Facility

$4,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,300.00
Max. Negotiated Rate	$4,462.00
Rate for Payer: AlohaCare Medicaid	$2,300.00
Rate for Payer: AlohaCare Medicare	$3,496.00
Rate for Payer: Cash Price	$2,760.00
Rate for Payer: Devoted Health Medicare	$3,864.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,496.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,220.00
Rate for Payer: Health Management Network Commercial	$3,910.00
Rate for Payer: Humana Medicare	$3,496.00
Rate for Payer: Kaiser Permanente Commercial	$4,140.00
Rate for Payer: Kaiser Permanente Medicaid	$2,346.00
Rate for Payer: Kaiser Permanente Medicare	$3,496.00
Rate for Payer: MDX Hawaii PPO	$4,462.00
Rate for Payer: Ohana Health Plan Medicaid	$3,496.00
Rate for Payer: Ohana Health Plan Medicare	$3,496.00
Rate for Payer: UnitedHealthcare Medicare	$3,496.00
Rate for Payer: University Health Alliance Commercial	$2,576.00

ANATOMIC GLENOID 5100-26-500

Facility

$8,436.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,218.00
Max. Negotiated Rate	$8,182.92
Rate for Payer: AlohaCare Medicaid	$4,218.00
Rate for Payer: AlohaCare Medicare	$6,411.36
Rate for Payer: Cash Price	$5,061.60
Rate for Payer: Devoted Health Medicare	$7,086.24
Rate for Payer: Hawaii Medical Service Association Medicare	$6,411.36
Rate for Payer: Hawaii Western Management Group Commercial	$5,905.20
Rate for Payer: Health Management Network Commercial	$7,170.60
Rate for Payer: Humana Medicare	$6,411.36
Rate for Payer: Kaiser Permanente Commercial	$7,592.40
Rate for Payer: Kaiser Permanente Medicaid	$4,302.36
Rate for Payer: Kaiser Permanente Medicare	$6,411.36
Rate for Payer: MDX Hawaii PPO	$8,182.92
Rate for Payer: Ohana Health Plan Medicaid	$6,411.36
Rate for Payer: Ohana Health Plan Medicare	$6,411.36
Rate for Payer: UnitedHealthcare Medicare	$6,411.36
Rate for Payer: University Health Alliance Commercial	$4,724.16

ANATOMIC GLENOID 5100-26-500

Facility

$8,436.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,724.16
Max. Negotiated Rate	$8,182.92
Rate for Payer: Cash Price	$5,061.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,905.20
Rate for Payer: Health Management Network Commercial	$7,170.60
Rate for Payer: Kaiser Permanente Commercial	$7,592.40
Rate for Payer: MDX Hawaii PPO	$8,182.92
Rate for Payer: University Health Alliance Commercial	$4,724.16

ANATOMIC LEFT MEDIAL 159541

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

ANATOMIC LEFT MEDIAL 159541

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

ANCHOR 2.6 FIBER AR-3632SP

Facility

$4,148.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,322.88
Max. Negotiated Rate	$4,023.56
Rate for Payer: Kaiser Permanente Commercial	$3,733.20
Rate for Payer: Cash Price	$2,488.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,903.60
Rate for Payer: Health Management Network Commercial	$3,525.80
Rate for Payer: MDX Hawaii PPO	$4,023.56
Rate for Payer: University Health Alliance Commercial	$2,322.88

ANCHOR 2.6 FIBER AR-3632SP

Facility

$4,148.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,074.00
Max. Negotiated Rate	$4,023.56
Rate for Payer: AlohaCare Medicaid	$2,074.00
Rate for Payer: AlohaCare Medicare	$3,152.48
Rate for Payer: Cash Price	$2,488.80
Rate for Payer: Devoted Health Medicare	$3,484.32
Rate for Payer: Hawaii Medical Service Association Medicare	$3,152.48
Rate for Payer: Hawaii Western Management Group Commercial	$2,903.60
Rate for Payer: Health Management Network Commercial	$3,525.80
Rate for Payer: Humana Medicare	$3,152.48
Rate for Payer: Kaiser Permanente Commercial	$3,733.20
Rate for Payer: Kaiser Permanente Medicaid	$2,115.48
Rate for Payer: Kaiser Permanente Medicare	$3,152.48
Rate for Payer: MDX Hawaii PPO	$4,023.56
Rate for Payer: Ohana Health Plan Medicaid	$3,152.48
Rate for Payer: Ohana Health Plan Medicare	$3,152.48
Rate for Payer: UnitedHealthcare Medicare	$3,152.48
Rate for Payer: University Health Alliance Commercial	$2,322.88

ANCHOR 2.9X15.5MM #AR-1923BC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,664.52
Rate for Payer: AlohaCare Medicaid	$858.00
Rate for Payer: AlohaCare Medicare	$1,304.16
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Devoted Health Medicare	$1,441.44
Rate for Payer: Hawaii Medical Service Association Medicare	$1,304.16
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Humana Medicare	$1,304.16
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: Kaiser Permanente Medicaid	$875.16
Rate for Payer: Kaiser Permanente Medicare	$1,304.16
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: Ohana Health Plan Medicaid	$1,304.16
Rate for Payer: Ohana Health Plan Medicare	$1,304.16
Rate for Payer: UnitedHealthcare Medicare	$1,304.16
Rate for Payer: University Health Alliance Commercial	$960.96

ANCHOR 2.9X15.5MM #AR-1923BC

Facility

$1,716.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$960.96
Max. Negotiated Rate	$1,664.52
Rate for Payer: Cash Price	$1,029.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,201.20
Rate for Payer: Health Management Network Commercial	$1,458.60
Rate for Payer: Kaiser Permanente Commercial	$1,544.40
Rate for Payer: MDX Hawaii PPO	$1,664.52
Rate for Payer: University Health Alliance Commercial	$960.96

ANCHOR 4.5 TWINFIX 72202893

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$625.52
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 4.5 TWINFIX 72202893

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$558.50
Max. Negotiated Rate	$1,083.49
Rate for Payer: AlohaCare Medicaid	$558.50
Rate for Payer: AlohaCare Medicare	$848.92
Rate for Payer: Cash Price	$670.20
Rate for Payer: Devoted Health Medicare	$938.28
Rate for Payer: Hawaii Medical Service Association Medicare	$848.92
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Humana Medicare	$848.92
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: Kaiser Permanente Medicaid	$569.67
Rate for Payer: Kaiser Permanente Medicare	$848.92
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: Ohana Health Plan Medicaid	$848.92
Rate for Payer: Ohana Health Plan Medicare	$848.92
Rate for Payer: UnitedHealthcare Medicare	$848.92
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 4.75 KNOTLESS SP

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,237.50
Max. Negotiated Rate	$2,400.75
Rate for Payer: AlohaCare Medicaid	$1,237.50
Rate for Payer: AlohaCare Medicare	$1,881.00
Rate for Payer: Cash Price	$1,485.00
Rate for Payer: Devoted Health Medicare	$2,079.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,881.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,732.50
Rate for Payer: Health Management Network Commercial	$2,103.75
Rate for Payer: Humana Medicare	$1,881.00
Rate for Payer: Kaiser Permanente Commercial	$2,227.50
Rate for Payer: Kaiser Permanente Medicaid	$1,262.25
Rate for Payer: Kaiser Permanente Medicare	$1,881.00
Rate for Payer: MDX Hawaii PPO	$2,400.75
Rate for Payer: Ohana Health Plan Medicaid	$1,881.00
Rate for Payer: Ohana Health Plan Medicare	$1,881.00
Rate for Payer: UnitedHealthcare Medicare	$1,881.00
Rate for Payer: University Health Alliance Commercial	$1,386.00

ANCHOR 4.75 KNOTLESS SP

Facility

$2,475.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,386.00
Max. Negotiated Rate	$2,400.75
Rate for Payer: Cash Price	$1,485.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,732.50
Rate for Payer: Health Management Network Commercial	$2,103.75
Rate for Payer: Kaiser Permanente Commercial	$2,227.50
Rate for Payer: MDX Hawaii PPO	$2,400.75
Rate for Payer: University Health Alliance Commercial	$1,386.00

ANCHOR 5.5 TWINFIX 72202895

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$625.52
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 5.5 TWINFIX 72202895

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$558.50
Max. Negotiated Rate	$1,083.49
Rate for Payer: AlohaCare Medicaid	$558.50
Rate for Payer: AlohaCare Medicare	$848.92
Rate for Payer: Cash Price	$670.20
Rate for Payer: Devoted Health Medicare	$938.28
Rate for Payer: Hawaii Medical Service Association Medicare	$848.92
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Humana Medicare	$848.92
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: Kaiser Permanente Medicaid	$569.67
Rate for Payer: Kaiser Permanente Medicare	$848.92
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: Ohana Health Plan Medicaid	$848.92
Rate for Payer: Ohana Health Plan Medicare	$848.92
Rate for Payer: UnitedHealthcare Medicare	$848.92
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 6.5 TI TWINFIX 72202898

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$625.52
Max. Negotiated Rate	$1,083.49
Rate for Payer: Cash Price	$670.20
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR 6.5 TI TWINFIX 72202898

Facility

$1,117.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$558.50
Max. Negotiated Rate	$1,083.49
Rate for Payer: AlohaCare Medicaid	$558.50
Rate for Payer: AlohaCare Medicare	$848.92
Rate for Payer: Cash Price	$670.20
Rate for Payer: Devoted Health Medicare	$938.28
Rate for Payer: Hawaii Medical Service Association Medicare	$848.92
Rate for Payer: Hawaii Western Management Group Commercial	$781.90
Rate for Payer: Health Management Network Commercial	$949.45
Rate for Payer: Humana Medicare	$848.92
Rate for Payer: Kaiser Permanente Commercial	$1,005.30
Rate for Payer: Kaiser Permanente Medicaid	$569.67
Rate for Payer: Kaiser Permanente Medicare	$848.92
Rate for Payer: MDX Hawaii PPO	$1,083.49
Rate for Payer: Ohana Health Plan Medicaid	$848.92
Rate for Payer: Ohana Health Plan Medicare	$848.92
Rate for Payer: UnitedHealthcare Medicare	$848.92
Rate for Payer: University Health Alliance Commercial	$625.52

ANCHOR BILATERAL KIT 2X ES0172

Facility

$1,383.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$691.50
Max. Negotiated Rate	$1,341.51
Rate for Payer: AlohaCare Medicaid	$691.50
Rate for Payer: AlohaCare Medicare	$1,051.08
Rate for Payer: Cash Price	$829.80
Rate for Payer: Devoted Health Medicare	$1,161.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,051.08
Rate for Payer: Hawaii Western Management Group Commercial	$968.10
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: Humana Medicare	$1,051.08
Rate for Payer: Kaiser Permanente Commercial	$1,244.70
Rate for Payer: Kaiser Permanente Medicaid	$705.33
Rate for Payer: Kaiser Permanente Medicare	$1,051.08
Rate for Payer: MDX Hawaii PPO	$1,341.51
Rate for Payer: Ohana Health Plan Medicaid	$1,051.08
Rate for Payer: Ohana Health Plan Medicare	$1,051.08
Rate for Payer: UnitedHealthcare Medicare	$1,051.08
Rate for Payer: University Health Alliance Commercial	$774.48

ANCHOR BILATERAL KIT 2X ES0172

Facility

$1,383.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$774.48
Max. Negotiated Rate	$1,341.51
Rate for Payer: Cash Price	$829.80
Rate for Payer: Hawaii Western Management Group Commercial	$968.10
Rate for Payer: Health Management Network Commercial	$1,175.55
Rate for Payer: Kaiser Permanente Commercial	$1,244.70
Rate for Payer: MDX Hawaii PPO	$1,341.51
Rate for Payer: University Health Alliance Commercial	$774.48

ANCHOR CORKSCREW AR-1927BCT

Facility

$1,243.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$621.50
Max. Negotiated Rate	$1,205.71
Rate for Payer: AlohaCare Medicaid	$621.50
Rate for Payer: AlohaCare Medicare	$944.68
Rate for Payer: Cash Price	$745.80
Rate for Payer: Devoted Health Medicare	$1,044.12
Rate for Payer: Hawaii Medical Service Association Medicare	$944.68
Rate for Payer: Hawaii Western Management Group Commercial	$870.10
Rate for Payer: Health Management Network Commercial	$1,056.55
Rate for Payer: Humana Medicare	$944.68
Rate for Payer: Kaiser Permanente Commercial	$1,118.70
Rate for Payer: Kaiser Permanente Medicaid	$633.93
Rate for Payer: Kaiser Permanente Medicare	$944.68
Rate for Payer: MDX Hawaii PPO	$1,205.71
Rate for Payer: Ohana Health Plan Medicaid	$944.68
Rate for Payer: Ohana Health Plan Medicare	$944.68
Rate for Payer: UnitedHealthcare Medicare	$944.68
Rate for Payer: University Health Alliance Commercial	$696.08

Know your out-of-pocket cost for care.

All Charges