Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

HUMERAL HEAD COCR DWN4615

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 DWN4615

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 COUPLER DWT100

Facility

$1,593.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$892.08
Max. Negotiated Rate	$1,545.21
Rate for Payer: Cash Price	$955.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: University Health Alliance Commercial	$892.08

HUMERAL HEAD COUPLER DWT100

Facility

$1,593.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$796.50
Max. Negotiated Rate	$1,545.21
Rate for Payer: AlohaCare Medicaid	$796.50
Rate for Payer: AlohaCare Medicare	$1,210.68
Rate for Payer: Cash Price	$955.80
Rate for Payer: Devoted Health Medicare	$1,338.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,210.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,115.10
Rate for Payer: Health Management Network Commercial	$1,354.05
Rate for Payer: Humana Medicare	$1,210.68
Rate for Payer: Kaiser Permanente Commercial	$1,433.70
Rate for Payer: Kaiser Permanente Medicaid	$812.43
Rate for Payer: Kaiser Permanente Medicare	$1,210.68
Rate for Payer: MDX Hawaii PPO	$1,545.21
Rate for Payer: Ohana Health Plan Medicaid	$1,210.68
Rate for Payer: Ohana Health Plan Medicare	$1,210.68
Rate for Payer: UnitedHealthcare Medicare	$1,210.68
Rate for Payer: University Health Alliance Commercial	$892.08

HUMERAL HEAD REMV AS 16X46

Facility

$3,356.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.36
Max. Negotiated Rate	$3,255.32
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.20
Rate for Payer: Health Management Network Commercial	$2,852.60
Rate for Payer: Kaiser Permanente Commercial	$3,020.40
Rate for Payer: MDX Hawaii PPO	$3,255.32
Rate for Payer: University Health Alliance Commercial	$1,879.36

HUMERAL HEAD REMV AS 16X46

Facility

$3,356.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,678.00
Max. Negotiated Rate	$3,255.32
Rate for Payer: AlohaCare Medicaid	$1,678.00
Rate for Payer: AlohaCare Medicare	$2,550.56
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Devoted Health Medicare	$2,819.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,550.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,349.20
Rate for Payer: Health Management Network Commercial	$2,852.60
Rate for Payer: Humana Medicare	$2,550.56
Rate for Payer: Kaiser Permanente Commercial	$3,020.40
Rate for Payer: Kaiser Permanente Medicaid	$1,711.56
Rate for Payer: Kaiser Permanente Medicare	$2,550.56
Rate for Payer: MDX Hawaii PPO	$3,255.32
Rate for Payer: Ohana Health Plan Medicaid	$2,550.56
Rate for Payer: Ohana Health Plan Medicare	$2,550.56
Rate for Payer: UnitedHealthcare Medicare	$2,550.56
Rate for Payer: University Health Alliance Commercial	$1,879.36

HUMERALHEAD SINGLE 5552-S-5622

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

HUMERALHEAD SINGLE 5552-S-5622

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 SNGL 5552-S-5220

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 SNGL 5552-S-5220

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 STB - COCR DWG044

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,417.00
Max. Negotiated Rate	$8,568.98
Rate for Payer: AlohaCare Medicaid	$4,417.00
Rate for Payer: AlohaCare Medicare	$6,713.84
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Devoted Health Medicare	$7,420.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6,713.84
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Humana Medicare	$6,713.84
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: Kaiser Permanente Medicaid	$4,505.34
Rate for Payer: Kaiser Permanente Medicare	$6,713.84
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: Ohana Health Plan Medicaid	$6,713.84
Rate for Payer: Ohana Health Plan Medicare	$6,713.84
Rate for Payer: UnitedHealthcare Medicare	$6,713.84
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB - COCR DWG044

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,947.04
Max. Negotiated Rate	$8,568.98
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB COCR DWG047

Facility

$9,036.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,060.16
Max. Negotiated Rate	$8,764.92
Rate for Payer: Cash Price	$5,421.60
Rate for Payer: Hawaii Western Management Group Commercial	$6,325.20
Rate for Payer: Health Management Network Commercial	$7,680.60
Rate for Payer: Kaiser Permanente Commercial	$8,132.40
Rate for Payer: MDX Hawaii PPO	$8,764.92
Rate for Payer: University Health Alliance Commercial	$5,060.16

HUMERAL HEAD STB COCR DWG047

Facility

$9,036.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,518.00
Max. Negotiated Rate	$8,764.92
Rate for Payer: AlohaCare Medicaid	$4,518.00
Rate for Payer: AlohaCare Medicare	$6,867.36
Rate for Payer: Cash Price	$5,421.60
Rate for Payer: Devoted Health Medicare	$7,590.24
Rate for Payer: Hawaii Medical Service Association Medicare	$6,867.36
Rate for Payer: Hawaii Western Management Group Commercial	$6,325.20
Rate for Payer: Health Management Network Commercial	$7,680.60
Rate for Payer: Humana Medicare	$6,867.36
Rate for Payer: Kaiser Permanente Commercial	$8,132.40
Rate for Payer: Kaiser Permanente Medicaid	$4,608.36
Rate for Payer: Kaiser Permanente Medicare	$6,867.36
Rate for Payer: MDX Hawaii PPO	$8,764.92
Rate for Payer: Ohana Health Plan Medicaid	$6,867.36
Rate for Payer: Ohana Health Plan Medicare	$6,867.36
Rate for Payer: UnitedHealthcare Medicare	$6,867.36
Rate for Payer: University Health Alliance Commercial	$5,060.16

HUMERAL HEAD STB - COCR DWG151

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,947.04
Max. Negotiated Rate	$8,568.98
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB - COCR DWG151

Facility

$8,834.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,417.00
Max. Negotiated Rate	$8,568.98
Rate for Payer: AlohaCare Medicaid	$4,417.00
Rate for Payer: AlohaCare Medicare	$6,713.84
Rate for Payer: Cash Price	$5,300.40
Rate for Payer: Devoted Health Medicare	$7,420.56
Rate for Payer: Hawaii Medical Service Association Medicare	$6,713.84
Rate for Payer: Hawaii Western Management Group Commercial	$6,183.80
Rate for Payer: Health Management Network Commercial	$7,508.90
Rate for Payer: Humana Medicare	$6,713.84
Rate for Payer: Kaiser Permanente Commercial	$7,950.60
Rate for Payer: Kaiser Permanente Medicaid	$4,505.34
Rate for Payer: Kaiser Permanente Medicare	$6,713.84
Rate for Payer: MDX Hawaii PPO	$8,568.98
Rate for Payer: Ohana Health Plan Medicaid	$6,713.84
Rate for Payer: Ohana Health Plan Medicare	$6,713.84
Rate for Payer: UnitedHealthcare Medicare	$6,713.84
Rate for Payer: University Health Alliance Commercial	$4,947.04

HUMERAL HEAD STB DWG152

Facility

$9,540.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,770.00
Max. Negotiated Rate	$9,253.80
Rate for Payer: AlohaCare Medicaid	$4,770.00
Rate for Payer: AlohaCare Medicare	$7,250.40
Rate for Payer: Cash Price	$5,724.00
Rate for Payer: Devoted Health Medicare	$8,013.60
Rate for Payer: Hawaii Medical Service Association Medicare	$7,250.40
Rate for Payer: Hawaii Western Management Group Commercial	$6,678.00
Rate for Payer: Health Management Network Commercial	$8,109.00
Rate for Payer: Humana Medicare	$7,250.40
Rate for Payer: Kaiser Permanente Commercial	$8,586.00
Rate for Payer: Kaiser Permanente Medicaid	$4,865.40
Rate for Payer: Kaiser Permanente Medicare	$7,250.40
Rate for Payer: MDX Hawaii PPO	$9,253.80
Rate for Payer: Ohana Health Plan Medicaid	$7,250.40
Rate for Payer: Ohana Health Plan Medicare	$7,250.40
Rate for Payer: UnitedHealthcare Medicare	$7,250.40
Rate for Payer: University Health Alliance Commercial	$5,342.40

HUMERAL HEAD STB DWG152

Facility

$9,540.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$5,342.40
Max. Negotiated Rate	$9,253.80
Rate for Payer: Cash Price	$5,724.00
Rate for Payer: Hawaii Western Management Group Commercial	$6,678.00
Rate for Payer: Health Management Network Commercial	$8,109.00
Rate for Payer: Kaiser Permanente Commercial	$8,586.00
Rate for Payer: MDX Hawaii PPO	$9,253.80
Rate for Payer: University Health Alliance Commercial	$5,342.40

HUMERAL INSERT 5571-S-3204-E

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: AlohaCare Medicaid	$1,600.00
Rate for Payer: AlohaCare Medicare	$2,432.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Devoted Health Medicare	$2,688.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,432.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Humana Medicare	$2,432.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: Kaiser Permanente Medicaid	$1,632.00
Rate for Payer: Kaiser Permanente Medicare	$2,432.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: Ohana Health Plan Medicaid	$2,432.00
Rate for Payer: Ohana Health Plan Medicare	$2,432.00
Rate for Payer: UnitedHealthcare Medicare	$2,432.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL INSERT 5571-S-3204-E

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL INSRT 36X4 5571-S-3604

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,792.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL INSRT 36X4 5571-S-3604

Facility

$3,200.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$3,104.00
Rate for Payer: AlohaCare Medicaid	$1,600.00
Rate for Payer: AlohaCare Medicare	$2,432.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Devoted Health Medicare	$2,688.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,432.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,240.00
Rate for Payer: Health Management Network Commercial	$2,720.00
Rate for Payer: Humana Medicare	$2,432.00
Rate for Payer: Kaiser Permanente Commercial	$2,880.00
Rate for Payer: Kaiser Permanente Medicaid	$1,632.00
Rate for Payer: Kaiser Permanente Medicare	$2,432.00
Rate for Payer: MDX Hawaii PPO	$3,104.00
Rate for Payer: Ohana Health Plan Medicaid	$2,432.00
Rate for Payer: Ohana Health Plan Medicare	$2,432.00
Rate for Payer: UnitedHealthcare Medicare	$2,432.00
Rate for Payer: University Health Alliance Commercial	$1,792.00

HUMERAL LF 72MM 02.117.701

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,588.72
Max. Negotiated Rate	$2,751.89
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: Kaiser Permanente Commercial	$2,553.30
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: University Health Alliance Commercial	$1,588.72

HUMERAL LF 72MM 02.117.701

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,418.50
Max. Negotiated Rate	$2,751.89
Rate for Payer: AlohaCare Medicaid	$1,418.50
Rate for Payer: AlohaCare Medicare	$2,156.12
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Devoted Health Medicare	$2,383.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,156.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: Humana Medicare	$2,156.12
Rate for Payer: Kaiser Permanente Commercial	$2,553.30
Rate for Payer: Kaiser Permanente Medicaid	$1,446.87
Rate for Payer: Kaiser Permanente Medicare	$2,156.12
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: Ohana Health Plan Medicaid	$2,156.12
Rate for Payer: Ohana Health Plan Medicare	$2,156.12
Rate for Payer: UnitedHealthcare Medicare	$2,156.12
Rate for Payer: University Health Alliance Commercial	$1,588.72

HUMERAL LF 88MM 02.117.304

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.50
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$2,089.24
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$2,309.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,089.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$2,089.24
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$2,089.24
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$2,089.24
Rate for Payer: Ohana Health Plan Medicare	$2,089.24
Rate for Payer: UnitedHealthcare Medicare	$2,089.24
Rate for Payer: University Health Alliance Commercial	$1,539.44

Know your out-of-pocket cost for care.

All Charges