Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HUMERAL FRACT STEM 5568-0006

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,738.72
Max. Negotiated Rate	$8,208.14
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: University Health Alliance Commercial	$4,738.72

HUMERAL FRACTUR STEM 5568-0013

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,231.00
Max. Negotiated Rate	$8,208.14
Rate for Payer: AlohaCare Medicaid	$4,231.00
Rate for Payer: AlohaCare Medicare	$6,431.12
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Devoted Health Medicare	$7,108.08
Rate for Payer: Hawaii Medical Service Association Medicare	$6,431.12
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Humana Medicare	$6,431.12
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: Kaiser Permanente Medicaid	$4,315.62
Rate for Payer: Kaiser Permanente Medicare	$6,431.12
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: Ohana Health Plan Medicaid	$6,431.12
Rate for Payer: Ohana Health Plan Medicare	$6,431.12
Rate for Payer: UnitedHealthcare Medicare	$6,431.12
Rate for Payer: University Health Alliance Commercial	$4,738.72

HUMERAL FRACTUR STEM 5568-0013

Facility

$8,462.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,738.72
Max. Negotiated Rate	$8,208.14
Rate for Payer: Cash Price	$5,077.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,923.40
Rate for Payer: Health Management Network Commercial	$7,192.70
Rate for Payer: Kaiser Permanente Commercial	$7,615.80
Rate for Payer: MDX Hawaii PPO	$8,208.14
Rate for Payer: University Health Alliance Commercial	$4,738.72

HUMERAL HD X42-15 01.04212.425

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

HUMERAL HD X42-15 01.04212.425

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

HUMERAL HEAD 19X56 5552-S-5619

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

HUMERAL HEAD 19X56 5552-S-5619

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

HUMERAL HEAD 40MM 110030776

Facility

$2,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,316.00
Max. Negotiated Rate	$2,279.50
Rate for Payer: Cash Price	$1,410.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.00
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Kaiser Permanente Commercial	$2,115.00
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: University Health Alliance Commercial	$1,316.00

HUMERAL HEAD 40MM 110030776

Facility

$2,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,175.00
Max. Negotiated Rate	$2,279.50
Rate for Payer: AlohaCare Medicaid	$1,175.00
Rate for Payer: AlohaCare Medicare	$1,786.00
Rate for Payer: Cash Price	$1,410.00
Rate for Payer: Devoted Health Medicare	$1,974.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,786.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,645.00
Rate for Payer: Health Management Network Commercial	$1,997.50
Rate for Payer: Humana Medicare	$1,786.00
Rate for Payer: Kaiser Permanente Commercial	$2,115.00
Rate for Payer: Kaiser Permanente Medicaid	$1,198.50
Rate for Payer: Kaiser Permanente Medicare	$1,786.00
Rate for Payer: MDX Hawaii PPO	$2,279.50
Rate for Payer: Ohana Health Plan Medicaid	$1,786.00
Rate for Payer: Ohana Health Plan Medicare	$1,786.00
Rate for Payer: UnitedHealthcare Medicare	$1,786.00
Rate for Payer: University Health Alliance Commercial	$1,316.00

HUMERAL HEAD 44X19 5552-S-4419

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

HUMERAL HEAD 44X19 5552-S-4419

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

HUMERAL HEAD 50/19 AR-9150-19P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: AlohaCare Medicaid	$1,750.00
Rate for Payer: AlohaCare Medicare	$2,660.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Devoted Health Medicare	$2,940.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,660.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$2,660.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: Kaiser Permanente Medicare	$2,660.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: Ohana Health Plan Medicaid	$2,660.00
Rate for Payer: Ohana Health Plan Medicare	$2,660.00
Rate for Payer: UnitedHealthcare Medicare	$2,660.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 50/19 AR-9150-19P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 52/20 AR-9152-20P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: AlohaCare Medicaid	$1,750.00
Rate for Payer: AlohaCare Medicare	$2,660.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Devoted Health Medicare	$2,940.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,660.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Humana Medicare	$2,660.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: Kaiser Permanente Medicaid	$1,785.00
Rate for Payer: Kaiser Permanente Medicare	$2,660.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: Ohana Health Plan Medicaid	$2,660.00
Rate for Payer: Ohana Health Plan Medicare	$2,660.00
Rate for Payer: UnitedHealthcare Medicare	$2,660.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 52/20 AR-9152-20P

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,960.00
Max. Negotiated Rate	$3,395.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,450.00
Rate for Payer: Health Management Network Commercial	$2,975.00
Rate for Payer: Kaiser Permanente Commercial	$3,150.00
Rate for Payer: MDX Hawaii PPO	$3,395.00
Rate for Payer: University Health Alliance Commercial	$1,960.00

HUMERAL HEAD 7122872

Facility

$11,146.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,241.76
Max. Negotiated Rate	$10,811.62
Rate for Payer: MDX Hawaii PPO	$10,811.62
Rate for Payer: Cash Price	$6,687.60
Rate for Payer: Hawaii Western Management Group Commercial	$7,802.20
Rate for Payer: Health Management Network Commercial	$9,474.10
Rate for Payer: Kaiser Permanente Commercial	$10,031.40
Rate for Payer: University Health Alliance Commercial	$6,241.76

HUMERAL HEAD 7122872

Facility

$11,146.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,573.00
Max. Negotiated Rate	$10,811.62
Rate for Payer: AlohaCare Medicaid	$5,573.00
Rate for Payer: AlohaCare Medicare	$8,470.96
Rate for Payer: Cash Price	$6,687.60
Rate for Payer: Devoted Health Medicare	$9,362.64
Rate for Payer: Hawaii Medical Service Association Medicare	$8,470.96
Rate for Payer: Hawaii Western Management Group Commercial	$7,802.20
Rate for Payer: Health Management Network Commercial	$9,474.10
Rate for Payer: Humana Medicare	$8,470.96
Rate for Payer: Kaiser Permanente Commercial	$10,031.40
Rate for Payer: Kaiser Permanente Medicaid	$5,684.46
Rate for Payer: Kaiser Permanente Medicare	$8,470.96
Rate for Payer: MDX Hawaii PPO	$10,811.62
Rate for Payer: Ohana Health Plan Medicaid	$8,470.96
Rate for Payer: Ohana Health Plan Medicare	$8,470.96
Rate for Payer: UnitedHealthcare Medicare	$8,470.96
Rate for Payer: University Health Alliance Commercial	$6,241.76

HUMERAL HEAD AS #01.04212.500

Facility

$4,794.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,684.64
Max. Negotiated Rate	$4,650.18
Rate for Payer: Cash Price	$2,876.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.80
Rate for Payer: Health Management Network Commercial	$4,074.90
Rate for Payer: Kaiser Permanente Commercial	$4,314.60
Rate for Payer: MDX Hawaii PPO	$4,650.18
Rate for Payer: University Health Alliance Commercial	$2,684.64

HUMERAL HEAD AS #01.04212.500

Facility

$4,794.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.00
Max. Negotiated Rate	$4,650.18
Rate for Payer: AlohaCare Medicaid	$2,397.00
Rate for Payer: AlohaCare Medicare	$3,643.44
Rate for Payer: Cash Price	$2,876.40
Rate for Payer: Devoted Health Medicare	$4,026.96
Rate for Payer: Hawaii Medical Service Association Medicare	$3,643.44
Rate for Payer: Hawaii Western Management Group Commercial	$3,355.80
Rate for Payer: Health Management Network Commercial	$4,074.90
Rate for Payer: Humana Medicare	$3,643.44
Rate for Payer: Kaiser Permanente Commercial	$4,314.60
Rate for Payer: Kaiser Permanente Medicaid	$2,444.94
Rate for Payer: Kaiser Permanente Medicare	$3,643.44
Rate for Payer: MDX Hawaii PPO	$4,650.18
Rate for Payer: Ohana Health Plan Medicaid	$3,643.44
Rate for Payer: Ohana Health Plan Medicare	$3,643.44
Rate for Payer: UnitedHealthcare Medicare	$3,643.44
Rate for Payer: University Health Alliance Commercial	$2,684.64

HUMERAL HEAD COCR 7122880

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,016.00
Max. Negotiated Rate	$5,851.04
Rate for Payer: AlohaCare Medicaid	$3,016.00
Rate for Payer: AlohaCare Medicare	$4,584.32
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Devoted Health Medicare	$5,066.88
Rate for Payer: Hawaii Medical Service Association Medicare	$4,584.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Humana Medicare	$4,584.32
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: Kaiser Permanente Medicaid	$3,076.32
Rate for Payer: Kaiser Permanente Medicare	$4,584.32
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: Ohana Health Plan Medicaid	$4,584.32
Rate for Payer: Ohana Health Plan Medicare	$4,584.32
Rate for Payer: UnitedHealthcare Medicare	$4,584.32
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR 7122880

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,377.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR DWG048

Facility

$8,306.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,153.00
Max. Negotiated Rate	$8,056.82
Rate for Payer: AlohaCare Medicaid	$4,153.00
Rate for Payer: AlohaCare Medicare	$6,312.56
Rate for Payer: Cash Price	$4,983.60
Rate for Payer: Devoted Health Medicare	$6,977.04
Rate for Payer: Hawaii Medical Service Association Medicare	$6,312.56
Rate for Payer: Hawaii Western Management Group Commercial	$5,814.20
Rate for Payer: Health Management Network Commercial	$7,060.10
Rate for Payer: Humana Medicare	$6,312.56
Rate for Payer: Kaiser Permanente Commercial	$7,475.40
Rate for Payer: Kaiser Permanente Medicaid	$4,236.06
Rate for Payer: Kaiser Permanente Medicare	$6,312.56
Rate for Payer: MDX Hawaii PPO	$8,056.82
Rate for Payer: Ohana Health Plan Medicaid	$6,312.56
Rate for Payer: Ohana Health Plan Medicare	$6,312.56
Rate for Payer: UnitedHealthcare Medicare	$6,312.56
Rate for Payer: University Health Alliance Commercial	$4,651.36

HUMERAL HEAD COCR DWG048

Facility

$8,306.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,651.36
Max. Negotiated Rate	$8,056.82
Rate for Payer: Cash Price	$4,983.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,814.20
Rate for Payer: Health Management Network Commercial	$7,060.10
Rate for Payer: Kaiser Permanente Commercial	$7,475.40
Rate for Payer: MDX Hawaii PPO	$8,056.82
Rate for Payer: University Health Alliance Commercial	$4,651.36

HUMERAL HEAD COCR DWN4314

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,016.00
Max. Negotiated Rate	$5,851.04
Rate for Payer: AlohaCare Medicaid	$3,016.00
Rate for Payer: AlohaCare Medicare	$4,584.32
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Devoted Health Medicare	$5,066.88
Rate for Payer: Hawaii Medical Service Association Medicare	$4,584.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Humana Medicare	$4,584.32
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: Kaiser Permanente Medicaid	$3,076.32
Rate for Payer: Kaiser Permanente Medicare	$4,584.32
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: Ohana Health Plan Medicaid	$4,584.32
Rate for Payer: Ohana Health Plan Medicare	$4,584.32
Rate for Payer: UnitedHealthcare Medicare	$4,584.32
Rate for Payer: University Health Alliance Commercial	$3,377.92

HUMERAL HEAD COCR DWN4314

Facility

$6,032.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,377.92
Max. Negotiated Rate	$5,851.04
Rate for Payer: Cash Price	$3,619.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,222.40
Rate for Payer: Health Management Network Commercial	$5,127.20
Rate for Payer: Kaiser Permanente Commercial	$5,428.80
Rate for Payer: MDX Hawaii PPO	$5,851.04
Rate for Payer: University Health Alliance Commercial	$3,377.92

Know your out-of-pocket cost for care.

All Charges