Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

INLINE TL CANN ASSM 51-10430

Facility

$1,244.00

Hospital Revenue Code	272
Min. Negotiated Rate	$622.00
Max. Negotiated Rate	$1,206.68
Rate for Payer: AlohaCare Medicaid	$622.00
Rate for Payer: AlohaCare Medicare	$945.44
Rate for Payer: Cash Price	$746.40
Rate for Payer: Devoted Health Medicare	$1,044.96
Rate for Payer: Hawaii Medical Service Association Medicare	$945.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,181.80
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Humana Medicare	$945.44
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: Kaiser Permanente Medicaid	$634.44
Rate for Payer: Kaiser Permanente Medicare	$945.44
Rate for Payer: MDX Hawaii PPO	$1,206.68
Rate for Payer: Ohana Health Plan Medicaid	$945.44
Rate for Payer: Ohana Health Plan Medicare	$945.44
Rate for Payer: UnitedHealthcare Medicare	$945.44
Rate for Payer: University Health Alliance Commercial	$906.75

INLINE TL CANN ASSM 51-10430

Facility

$1,244.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,057.40
Max. Negotiated Rate	$1,206.68
Rate for Payer: Cash Price	$746.40
Rate for Payer: Health Management Network Commercial	$1,057.40
Rate for Payer: Kaiser Permanente Commercial	$1,119.60
Rate for Payer: MDX Hawaii PPO	$1,206.68

INNER VISION 50FR TIP 1465-50

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$382.50
Max. Negotiated Rate	$436.50
Rate for Payer: Cash Price	$270.00
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: MDX Hawaii PPO	$436.50

INNER VISION 50FR TIP 1465-50

Facility

$450.00

Hospital Revenue Code	272
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$436.50
Rate for Payer: AlohaCare Medicaid	$225.00
Rate for Payer: AlohaCare Medicare	$342.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Devoted Health Medicare	$378.00
Rate for Payer: Hawaii Medical Service Association Medicare	$342.00
Rate for Payer: Hawaii Western Management Group Commercial	$427.50
Rate for Payer: Health Management Network Commercial	$382.50
Rate for Payer: Humana Medicare	$342.00
Rate for Payer: Kaiser Permanente Commercial	$405.00
Rate for Payer: Kaiser Permanente Medicaid	$229.50
Rate for Payer: Kaiser Permanente Medicare	$342.00
Rate for Payer: MDX Hawaii PPO	$436.50
Rate for Payer: Ohana Health Plan Medicaid	$342.00
Rate for Payer: Ohana Health Plan Medicare	$342.00
Rate for Payer: UnitedHealthcare Medicare	$342.00
Rate for Payer: University Health Alliance Commercial	$328.00

INSERT ACETABULAR 7236-2-848

Facility

$3,211.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,798.16
Max. Negotiated Rate	$3,114.67
Rate for Payer: Cash Price	$1,926.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,247.70
Rate for Payer: Health Management Network Commercial	$2,729.35
Rate for Payer: Kaiser Permanente Commercial	$2,889.90
Rate for Payer: MDX Hawaii PPO	$3,114.67
Rate for Payer: University Health Alliance Commercial	$1,798.16

INSERT ACETABULAR 7236-2-848

Facility

$3,211.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,605.50
Max. Negotiated Rate	$3,114.67
Rate for Payer: AlohaCare Medicaid	$1,605.50
Rate for Payer: AlohaCare Medicare	$2,440.36
Rate for Payer: Cash Price	$1,926.60
Rate for Payer: Devoted Health Medicare	$2,697.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,440.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,247.70
Rate for Payer: Health Management Network Commercial	$2,729.35
Rate for Payer: Humana Medicare	$2,440.36
Rate for Payer: Kaiser Permanente Commercial	$2,889.90
Rate for Payer: Kaiser Permanente Medicaid	$1,637.61
Rate for Payer: Kaiser Permanente Medicare	$2,440.36
Rate for Payer: MDX Hawaii PPO	$3,114.67
Rate for Payer: Ohana Health Plan Medicaid	$2,440.36
Rate for Payer: Ohana Health Plan Medicare	$2,440.36
Rate for Payer: UnitedHealthcare Medicare	$2,440.36
Rate for Payer: University Health Alliance Commercial	$1,798.16

INSERT ADM MDM X3 1236-2-852

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,622.00
Max. Negotiated Rate	$3,146.68
Rate for Payer: AlohaCare Medicaid	$1,622.00
Rate for Payer: AlohaCare Medicare	$2,465.44
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Devoted Health Medicare	$2,724.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2,465.44
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Humana Medicare	$2,465.44
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: Kaiser Permanente Medicaid	$1,654.44
Rate for Payer: Kaiser Permanente Medicare	$2,465.44
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: Ohana Health Plan Medicaid	$2,465.44
Rate for Payer: Ohana Health Plan Medicare	$2,465.44
Rate for Payer: UnitedHealthcare Medicare	$2,465.44
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT ADM MDM X3 1236-2-852

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,816.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT ADM/MDM X3 1236-2-854

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,816.64
Max. Negotiated Rate	$3,146.68
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT ADM/MDM X3 1236-2-854

Facility

$3,244.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,622.00
Max. Negotiated Rate	$3,146.68
Rate for Payer: AlohaCare Medicaid	$1,622.00
Rate for Payer: AlohaCare Medicare	$2,465.44
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Devoted Health Medicare	$2,724.96
Rate for Payer: Hawaii Medical Service Association Medicare	$2,465.44
Rate for Payer: Hawaii Western Management Group Commercial	$2,270.80
Rate for Payer: Health Management Network Commercial	$2,757.40
Rate for Payer: Humana Medicare	$2,465.44
Rate for Payer: Kaiser Permanente Commercial	$2,919.60
Rate for Payer: Kaiser Permanente Medicaid	$1,654.44
Rate for Payer: Kaiser Permanente Medicare	$2,465.44
Rate for Payer: MDX Hawaii PPO	$3,146.68
Rate for Payer: Ohana Health Plan Medicaid	$2,465.44
Rate for Payer: Ohana Health Plan Medicare	$2,465.44
Rate for Payer: UnitedHealthcare Medicare	$2,465.44
Rate for Payer: University Health Alliance Commercial	$1,816.64

INSERT BEARING 5532-G-413-E

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

INSERT BEARING 5532-G-413-E

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

INSERT CR SZ 6 6MM 1516-20-606

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: AlohaCare Medicaid	$1,500.00
Rate for Payer: AlohaCare Medicare	$2,280.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Devoted Health Medicare	$2,520.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Humana Medicare	$2,280.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: Kaiser Permanente Medicaid	$1,530.00
Rate for Payer: Kaiser Permanente Medicare	$2,280.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: Ohana Health Plan Medicaid	$2,280.00
Rate for Payer: Ohana Health Plan Medicare	$2,280.00
Rate for Payer: UnitedHealthcare Medicare	$2,280.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

INSERT CR SZ 6 6MM 1516-20-606

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$2,910.00
Rate for Payer: Cash Price	$1,800.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,100.00
Rate for Payer: Health Management Network Commercial	$2,550.00
Rate for Payer: Kaiser Permanente Commercial	$2,700.00
Rate for Payer: MDX Hawaii PPO	$2,910.00
Rate for Payer: University Health Alliance Commercial	$1,680.00

INSERT E-VITALIZ SZ6 166-7613

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,275.00
Max. Negotiated Rate	$8,293.50
Rate for Payer: AlohaCare Medicaid	$4,275.00
Rate for Payer: AlohaCare Medicare	$6,498.00
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Devoted Health Medicare	$7,182.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,498.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Humana Medicare	$6,498.00
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: Kaiser Permanente Medicaid	$4,360.50
Rate for Payer: Kaiser Permanente Medicare	$6,498.00
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: Ohana Health Plan Medicaid	$6,498.00
Rate for Payer: Ohana Health Plan Medicare	$6,498.00
Rate for Payer: UnitedHealthcare Medicare	$6,498.00
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT E-VITALIZ SZ6 166-7613

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,788.00
Max. Negotiated Rate	$8,293.50
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT E-VITALIZ SZ7 166-5712

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,275.00
Max. Negotiated Rate	$8,293.50
Rate for Payer: AlohaCare Medicaid	$4,275.00
Rate for Payer: AlohaCare Medicare	$6,498.00
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Devoted Health Medicare	$7,182.00
Rate for Payer: Hawaii Medical Service Association Medicare	$6,498.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Humana Medicare	$6,498.00
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: Kaiser Permanente Medicaid	$4,360.50
Rate for Payer: Kaiser Permanente Medicare	$6,498.00
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: Ohana Health Plan Medicaid	$6,498.00
Rate for Payer: Ohana Health Plan Medicare	$6,498.00
Rate for Payer: UnitedHealthcare Medicare	$6,498.00
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT E-VITALIZ SZ7 166-5712

Facility

$8,550.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,788.00
Max. Negotiated Rate	$8,293.50
Rate for Payer: Cash Price	$5,130.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,985.00
Rate for Payer: Health Management Network Commercial	$7,267.50
Rate for Payer: Kaiser Permanente Commercial	$7,695.00
Rate for Payer: MDX Hawaii PPO	$8,293.50
Rate for Payer: University Health Alliance Commercial	$4,788.00

INSERT HINGE TRIATH 5612-P-511

Facility

$5,870.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,935.00
Max. Negotiated Rate	$5,693.90
Rate for Payer: AlohaCare Medicaid	$2,935.00
Rate for Payer: AlohaCare Medicare	$4,461.20
Rate for Payer: Cash Price	$3,522.00
Rate for Payer: Devoted Health Medicare	$4,930.80
Rate for Payer: Hawaii Medical Service Association Medicare	$4,461.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,109.00
Rate for Payer: Health Management Network Commercial	$4,989.50
Rate for Payer: Humana Medicare	$4,461.20
Rate for Payer: Kaiser Permanente Commercial	$5,283.00
Rate for Payer: Kaiser Permanente Medicaid	$2,993.70
Rate for Payer: Kaiser Permanente Medicare	$4,461.20
Rate for Payer: MDX Hawaii PPO	$5,693.90
Rate for Payer: Ohana Health Plan Medicaid	$4,461.20
Rate for Payer: Ohana Health Plan Medicare	$4,461.20
Rate for Payer: UnitedHealthcare Medicare	$4,461.20
Rate for Payer: University Health Alliance Commercial	$3,287.20

INSERT HINGE TRIATH 5612-P-511

Facility

$5,870.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,287.20
Max. Negotiated Rate	$5,693.90
Rate for Payer: Cash Price	$3,522.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,109.00
Rate for Payer: Health Management Network Commercial	$4,989.50
Rate for Payer: Kaiser Permanente Commercial	$5,283.00
Rate for Payer: MDX Hawaii PPO	$5,693.90
Rate for Payer: University Health Alliance Commercial	$3,287.20

INSERT HUMERAL X3 5571-C-3608

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

INSERT HUMERAL X3 5571-C-3608

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

INSERT HUMERL 32X4 5571-S-3204

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

INSERT HUMERL 32X4 5571-S-3204

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

INSERT HUM S36/+3 AR-9503S-03

Facility

$2,030.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,015.00
Max. Negotiated Rate	$1,969.10
Rate for Payer: Kaiser Permanente Medicare	$1,542.80
Rate for Payer: AlohaCare Medicaid	$1,015.00
Rate for Payer: AlohaCare Medicare	$1,542.80
Rate for Payer: Cash Price	$1,218.00
Rate for Payer: Devoted Health Medicare	$1,705.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,542.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,421.00
Rate for Payer: Health Management Network Commercial	$1,725.50
Rate for Payer: Humana Medicare	$1,542.80
Rate for Payer: Kaiser Permanente Commercial	$1,827.00
Rate for Payer: Kaiser Permanente Medicaid	$1,035.30
Rate for Payer: MDX Hawaii PPO	$1,969.10
Rate for Payer: Ohana Health Plan Medicaid	$1,542.80
Rate for Payer: Ohana Health Plan Medicare	$1,542.80
Rate for Payer: UnitedHealthcare Medicare	$1,542.80
Rate for Payer: University Health Alliance Commercial	$1,136.80

Know your out-of-pocket cost for care.

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