Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC

Facility

$34,960.45

Service Code	MSDRG 482
Min. Negotiated Rate	$34,960.45
Max. Negotiated Rate	$34,960.45
Rate for Payer: Hawaii Medical Service Association Commercial	$34,960.45

HIP CRYO CUFF 14A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$90.50
Max. Negotiated Rate	$175.57
Rate for Payer: AlohaCare Medicaid	$90.50
Rate for Payer: AlohaCare Medicare	$137.56
Rate for Payer: Cash Price	$108.60
Rate for Payer: Devoted Health Medicare	$152.04
Rate for Payer: Hawaii Medical Service Association Medicare	$137.56
Rate for Payer: Hawaii Western Management Group Commercial	$171.95
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Humana Medicare	$137.56
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: Kaiser Permanente Medicaid	$92.31
Rate for Payer: Kaiser Permanente Medicare	$137.56
Rate for Payer: MDX Hawaii PPO	$175.57
Rate for Payer: Ohana Health Plan Medicaid	$137.56
Rate for Payer: Ohana Health Plan Medicare	$137.56
Rate for Payer: UnitedHealthcare Medicare	$137.56
Rate for Payer: University Health Alliance Commercial	$131.93

HIP CRYO CUFF 14A01

Facility

$181.00

Hospital Revenue Code	272
Min. Negotiated Rate	$153.85
Max. Negotiated Rate	$175.57
Rate for Payer: Cash Price	$108.60
Rate for Payer: Health Management Network Commercial	$153.85
Rate for Payer: Kaiser Permanente Commercial	$162.90
Rate for Payer: MDX Hawaii PPO	$175.57

HIP LINER 36X54 00-8751-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP LINER 36X54 00-8751-011-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP LINER 36X56 00-8751-012-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP LINER 36X56 00-8751-012-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP LINER 36X60 00-8751-014-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP LINER 36X60 00-8751-014-36

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP LINER 40X56 00-8751-012-40

Facility

$3,270.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,831.20
Max. Negotiated Rate	$3,171.90
Rate for Payer: Cash Price	$1,962.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,289.00
Rate for Payer: Health Management Network Commercial	$2,779.50
Rate for Payer: Kaiser Permanente Commercial	$2,943.00
Rate for Payer: MDX Hawaii PPO	$3,171.90
Rate for Payer: University Health Alliance Commercial	$1,831.20

HIP LINER 40X56 00-8751-012-40

Facility

$3,270.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.00
Max. Negotiated Rate	$3,171.90
Rate for Payer: AlohaCare Medicaid	$1,635.00
Rate for Payer: AlohaCare Medicare	$2,485.20
Rate for Payer: Cash Price	$1,962.00
Rate for Payer: Devoted Health Medicare	$2,746.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,485.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,289.00
Rate for Payer: Health Management Network Commercial	$2,779.50
Rate for Payer: Humana Medicare	$2,485.20
Rate for Payer: Kaiser Permanente Commercial	$2,943.00
Rate for Payer: Kaiser Permanente Medicaid	$1,667.70
Rate for Payer: Kaiser Permanente Medicare	$2,485.20
Rate for Payer: MDX Hawaii PPO	$3,171.90
Rate for Payer: Ohana Health Plan Medicaid	$2,485.20
Rate for Payer: Ohana Health Plan Medicare	$2,485.20
Rate for Payer: UnitedHealthcare Medicare	$2,485.20
Rate for Payer: University Health Alliance Commercial	$1,831.20

HIP LINER 40X60 00-8751-014-40

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,568.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP LINER 40X60 00-8751-014-40

Facility

$2,800.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,400.00
Max. Negotiated Rate	$2,716.00
Rate for Payer: AlohaCare Medicaid	$1,400.00
Rate for Payer: AlohaCare Medicare	$2,128.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Devoted Health Medicare	$2,352.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,128.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,960.00
Rate for Payer: Health Management Network Commercial	$2,380.00
Rate for Payer: Humana Medicare	$2,128.00
Rate for Payer: Kaiser Permanente Commercial	$2,520.00
Rate for Payer: Kaiser Permanente Medicaid	$1,428.00
Rate for Payer: Kaiser Permanente Medicare	$2,128.00
Rate for Payer: MDX Hawaii PPO	$2,716.00
Rate for Payer: Ohana Health Plan Medicaid	$2,128.00
Rate for Payer: Ohana Health Plan Medicare	$2,128.00
Rate for Payer: UnitedHealthcare Medicare	$2,128.00
Rate for Payer: University Health Alliance Commercial	$1,568.00

HIP PAC DISPOSABLE

Facility

$2,246.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
Min. Negotiated Rate	$1,909.10
Max. Negotiated Rate	$2,178.62
Rate for Payer: Cash Price	$1,347.60
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

HIP PAC DISPOSABLE

Facility

$2,246.00

Service Code	HCPCS C1769
Hospital Revenue Code	272
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	$2,133.70
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	$1,637.11

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

Facility

$50,580.07

Service Code	MSDRG 521
Min. Negotiated Rate	$50,580.07
Max. Negotiated Rate	$50,580.07
Rate for Payer: Hawaii Medical Service Association Commercial	$50,580.07

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

Facility

$36,880.31

Service Code	MSDRG 522
Min. Negotiated Rate	$36,880.31
Max. Negotiated Rate	$36,880.31
Rate for Payer: Hawaii Medical Service Association Commercial	$36,880.31

HIP STEM #10 35X160 6051-1035S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,236.80
Max. Negotiated Rate	$5,606.60
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM #10 35X160 6051-1035S

Facility

$5,780.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,890.00
Max. Negotiated Rate	$5,606.60
Rate for Payer: AlohaCare Medicaid	$2,890.00
Rate for Payer: AlohaCare Medicare	$4,392.80
Rate for Payer: Cash Price	$3,468.00
Rate for Payer: Devoted Health Medicare	$4,855.20
Rate for Payer: Hawaii Medical Service Association Medicare	$4,392.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,046.00
Rate for Payer: Health Management Network Commercial	$4,913.00
Rate for Payer: Humana Medicare	$4,392.80
Rate for Payer: Kaiser Permanente Commercial	$5,202.00
Rate for Payer: Kaiser Permanente Medicaid	$2,947.80
Rate for Payer: Kaiser Permanente Medicare	$4,392.80
Rate for Payer: MDX Hawaii PPO	$5,606.60
Rate for Payer: Ohana Health Plan Medicaid	$4,392.80
Rate for Payer: Ohana Health Plan Medicare	$4,392.80
Rate for Payer: UnitedHealthcare Medicare	$4,392.80
Rate for Payer: University Health Alliance Commercial	$3,236.80

HIP STEM 11 STD 00-7711-11-10

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,600.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: AlohaCare Medicaid	$2,600.00
Rate for Payer: AlohaCare Medicare	$3,952.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Devoted Health Medicare	$4,368.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,952.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Humana Medicare	$3,952.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: Kaiser Permanente Medicaid	$2,652.00
Rate for Payer: Kaiser Permanente Medicare	$3,952.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: Ohana Health Plan Medicaid	$3,952.00
Rate for Payer: Ohana Health Plan Medicare	$3,952.00
Rate for Payer: UnitedHealthcare Medicare	$3,952.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 11 STD 00-7711-11-10

Facility

$5,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$5,044.00
Rate for Payer: Cash Price	$3,120.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,640.00
Rate for Payer: Health Management Network Commercial	$4,420.00
Rate for Payer: Kaiser Permanente Commercial	$4,680.00
Rate for Payer: MDX Hawaii PPO	$5,044.00
Rate for Payer: University Health Alliance Commercial	$2,912.00

HIP STEM 11X120 00-7833-011-00

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,408.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

HIP STEM 11X120 00-7833-011-00

Facility

$4,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,150.00
Max. Negotiated Rate	$4,171.00
Rate for Payer: AlohaCare Medicaid	$2,150.00
Rate for Payer: AlohaCare Medicare	$3,268.00
Rate for Payer: Cash Price	$2,580.00
Rate for Payer: Devoted Health Medicare	$3,612.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,268.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,010.00
Rate for Payer: Health Management Network Commercial	$3,655.00
Rate for Payer: Humana Medicare	$3,268.00
Rate for Payer: Kaiser Permanente Commercial	$3,870.00
Rate for Payer: Kaiser Permanente Medicaid	$2,193.00
Rate for Payer: Kaiser Permanente Medicare	$3,268.00
Rate for Payer: MDX Hawaii PPO	$4,171.00
Rate for Payer: Ohana Health Plan Medicaid	$3,268.00
Rate for Payer: Ohana Health Plan Medicare	$3,268.00
Rate for Payer: UnitedHealthcare Medicare	$3,268.00
Rate for Payer: University Health Alliance Commercial	$2,408.00

HIP STEM #12 40X170 6051-1240S

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,269.84
Max. Negotiated Rate	$5,663.83
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: University Health Alliance Commercial	$3,269.84

HIP STEM #12 40X170 6051-1240S

Facility

$5,839.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,919.50
Max. Negotiated Rate	$5,663.83
Rate for Payer: AlohaCare Medicaid	$2,919.50
Rate for Payer: AlohaCare Medicare	$4,437.64
Rate for Payer: Cash Price	$3,503.40
Rate for Payer: Devoted Health Medicare	$4,904.76
Rate for Payer: Hawaii Medical Service Association Medicare	$4,437.64
Rate for Payer: Hawaii Western Management Group Commercial	$4,087.30
Rate for Payer: Health Management Network Commercial	$4,963.15
Rate for Payer: Humana Medicare	$4,437.64
Rate for Payer: Kaiser Permanente Commercial	$5,255.10
Rate for Payer: Kaiser Permanente Medicaid	$2,977.89
Rate for Payer: Kaiser Permanente Medicare	$4,437.64
Rate for Payer: MDX Hawaii PPO	$5,663.83
Rate for Payer: Ohana Health Plan Medicaid	$4,437.64
Rate for Payer: Ohana Health Plan Medicare	$4,437.64
Rate for Payer: UnitedHealthcare Medicare	$4,437.64
Rate for Payer: University Health Alliance Commercial	$3,269.84

Know your out-of-pocket cost for care.

All Charges