Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HEADACHES WITH MCC

Facility

$15,667.02

Service Code	MSDRG 102
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEADACHES WITHOUT MCC

Facility

$15,667.02

Service Code	MSDRG 103
Min. Negotiated Rate	$15,667.02
Max. Negotiated Rate	$15,667.02
Rate for Payer: Hawaii Medical Service Association Commercial	$15,667.02

HEAD EVOLVE PROLINE 20 496H020

Facility

$4,452.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,493.12
Max. Negotiated Rate	$4,318.44
Rate for Payer: Cash Price	$2,671.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,116.40
Rate for Payer: Health Management Network Commercial	$3,784.20
Rate for Payer: Kaiser Permanente Commercial	$4,006.80
Rate for Payer: MDX Hawaii PPO	$4,318.44
Rate for Payer: University Health Alliance Commercial	$2,493.12

HEAD EVOLVE PROLINE 20 496H020

Facility

$4,452.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,226.00
Max. Negotiated Rate	$4,318.44
Rate for Payer: AlohaCare Medicaid	$2,226.00
Rate for Payer: AlohaCare Medicare	$3,383.52
Rate for Payer: Cash Price	$2,671.20
Rate for Payer: Devoted Health Medicare	$3,739.68
Rate for Payer: Hawaii Medical Service Association Medicare	$3,383.52
Rate for Payer: Hawaii Western Management Group Commercial	$3,116.40
Rate for Payer: Health Management Network Commercial	$3,784.20
Rate for Payer: Humana Medicare	$3,383.52
Rate for Payer: Kaiser Permanente Commercial	$4,006.80
Rate for Payer: Kaiser Permanente Medicaid	$2,270.52
Rate for Payer: Kaiser Permanente Medicare	$3,383.52
Rate for Payer: MDX Hawaii PPO	$4,318.44
Rate for Payer: Ohana Health Plan Medicaid	$3,383.52
Rate for Payer: Ohana Health Plan Medicare	$3,383.52
Rate for Payer: UnitedHealthcare Medicare	$3,383.52
Rate for Payer: University Health Alliance Commercial	$2,493.12

HEAD FEMORAL 26MM 6260-9-226

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

HEAD FEMORAL 26MM 6260-9-226

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

HEAD FEMORAL 28MM 6260-9-228

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

HEAD FEMORAL 28MM 6260-9-228

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

HEAD FEMORAL 28MM 6570-0-028

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

HEAD FEMORAL 28MM 6570-0-028

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

HEAD FEMORAL 36+5MM 6570-0-236

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

HEAD FEMORAL 36+5MM 6570-0-236

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

HEAD FEMORAL 36MM 6260-9-136

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

HEAD FEMORAL 36MM 6260-9-136

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

HEAD FEMOR LFIT V40 6260-9-328

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

HEAD FEMOR LFIT V40 6260-9-328

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

HEAD HUM 48X15MM 5552-S-4815

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,033.50
Max. Negotiated Rate	$3,944.99
Rate for Payer: AlohaCare Medicaid	$2,033.50
Rate for Payer: AlohaCare Medicare	$3,090.92
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Devoted Health Medicare	$3,416.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,090.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Humana Medicare	$3,090.92
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: Kaiser Permanente Medicare	$3,090.92
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: Ohana Health Plan Medicaid	$3,090.92
Rate for Payer: Ohana Health Plan Medicare	$3,090.92
Rate for Payer: UnitedHealthcare Medicare	$3,090.92
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUM 48X15MM 5552-S-4815

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUM 48X18MM 5552-S-4818

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,033.50
Max. Negotiated Rate	$3,944.99
Rate for Payer: AlohaCare Medicaid	$2,033.50
Rate for Payer: AlohaCare Medicare	$3,090.92
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Devoted Health Medicare	$3,416.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,090.92
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Humana Medicare	$3,090.92
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: Kaiser Permanente Medicaid	$2,074.17
Rate for Payer: Kaiser Permanente Medicare	$3,090.92
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: Ohana Health Plan Medicaid	$3,090.92
Rate for Payer: Ohana Health Plan Medicare	$3,090.92
Rate for Payer: UnitedHealthcare Medicare	$3,090.92
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUM 48X18MM 5552-S-4818

Facility

$4,067.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,277.52
Max. Negotiated Rate	$3,944.99
Rate for Payer: Cash Price	$2,440.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,846.90
Rate for Payer: Health Management Network Commercial	$3,456.95
Rate for Payer: Kaiser Permanente Commercial	$3,660.30
Rate for Payer: MDX Hawaii PPO	$3,944.99
Rate for Payer: University Health Alliance Commercial	$2,277.52

HEAD HUMERAL 44/17 AR-9144-17P

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

HEAD HUMERAL 44/17 AR-9144-17P

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

HEAD HUMERAL X36-12

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

HEAD HUMERAL X36-12

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

HEAD HUMERAL X38-13

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

Know your out-of-pocket cost for care.

All Charges