Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

KNEE LEFT SZH 42-5380-008-01

Facility

$2,940.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.40
Max. Negotiated Rate	$2,851.80
Rate for Payer: Cash Price	$1,764.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,058.00
Rate for Payer: Health Management Network Commercial	$2,499.00
Rate for Payer: Kaiser Permanente Commercial	$2,646.00
Rate for Payer: MDX Hawaii PPO	$2,851.80
Rate for Payer: University Health Alliance Commercial	$1,646.40

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC

Facility

$24,934.50

Service Code	MSDRG 488
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$24,934.50

Service Code	MSDRG 489
Min. Negotiated Rate	$24,934.50
Max. Negotiated Rate	$24,934.50
Rate for Payer: Hawaii Medical Service Association Commercial	$24,934.50

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC

Facility

$44,156.83

Service Code	MSDRG 486
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC

Facility

$44,156.83

Service Code	MSDRG 485
Min. Negotiated Rate	$44,156.83
Max. Negotiated Rate	$44,156.83
Rate for Payer: Hawaii Medical Service Association Commercial	$44,156.83

KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC

Facility

$31,547.36

Service Code	MSDRG 487
Min. Negotiated Rate	$31,547.36
Max. Negotiated Rate	$31,547.36
Rate for Payer: Hawaii Medical Service Association Commercial	$31,547.36

KNEE SYS SZ/3 L 42-5182-005-08

Facility

$2,661.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,330.50
Max. Negotiated Rate	$2,581.17
Rate for Payer: AlohaCare Medicaid	$1,330.50
Rate for Payer: AlohaCare Medicare	$2,022.36
Rate for Payer: Cash Price	$1,596.60
Rate for Payer: Devoted Health Medicare	$2,235.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,022.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.70
Rate for Payer: Health Management Network Commercial	$2,261.85
Rate for Payer: Humana Medicare	$2,022.36
Rate for Payer: Kaiser Permanente Commercial	$2,394.90
Rate for Payer: Kaiser Permanente Medicaid	$1,357.11
Rate for Payer: Kaiser Permanente Medicare	$2,022.36
Rate for Payer: MDX Hawaii PPO	$2,581.17
Rate for Payer: Ohana Health Plan Medicaid	$2,022.36
Rate for Payer: Ohana Health Plan Medicare	$2,022.36
Rate for Payer: UnitedHealthcare Medicare	$2,022.36
Rate for Payer: University Health Alliance Commercial	$1,490.16

KNEE SYS SZ/3 L 42-5182-005-08

Facility

$2,661.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,490.16
Max. Negotiated Rate	$2,581.17
Rate for Payer: Cash Price	$1,596.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,862.70
Rate for Payer: Health Management Network Commercial	$2,261.85
Rate for Payer: Kaiser Permanente Commercial	$2,394.90
Rate for Payer: MDX Hawaii PPO	$2,581.17
Rate for Payer: University Health Alliance Commercial	$1,490.16

KNEE SYS SZ/E L 42-5380-005-01

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,876.00
Max. Negotiated Rate	$3,249.50
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: University Health Alliance Commercial	$1,876.00

KNEE SYS SZ/E L 42-5380-005-01

Facility

$3,350.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,675.00
Max. Negotiated Rate	$3,249.50
Rate for Payer: AlohaCare Medicaid	$1,675.00
Rate for Payer: AlohaCare Medicare	$2,546.00
Rate for Payer: Cash Price	$2,010.00
Rate for Payer: Devoted Health Medicare	$2,814.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,546.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,345.00
Rate for Payer: Health Management Network Commercial	$2,847.50
Rate for Payer: Humana Medicare	$2,546.00
Rate for Payer: Kaiser Permanente Commercial	$3,015.00
Rate for Payer: Kaiser Permanente Medicaid	$1,708.50
Rate for Payer: Kaiser Permanente Medicare	$2,546.00
Rate for Payer: MDX Hawaii PPO	$3,249.50
Rate for Payer: Ohana Health Plan Medicaid	$2,546.00
Rate for Payer: Ohana Health Plan Medicare	$2,546.00
Rate for Payer: UnitedHealthcare Medicare	$2,546.00
Rate for Payer: University Health Alliance Commercial	$1,876.00

KNEE SYSTEM PARTIAL RT 159532

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,650.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: AlohaCare Medicaid	$1,650.00
Rate for Payer: AlohaCare Medicare	$2,508.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Devoted Health Medicare	$2,772.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,508.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Humana Medicare	$2,508.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: Kaiser Permanente Medicaid	$1,683.00
Rate for Payer: Kaiser Permanente Medicare	$2,508.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: Ohana Health Plan Medicaid	$2,508.00
Rate for Payer: Ohana Health Plan Medicare	$2,508.00
Rate for Payer: UnitedHealthcare Medicare	$2,508.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

KNEE SYSTEM PARTIAL RT 159532

Facility

$3,300.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,848.00
Max. Negotiated Rate	$3,201.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,310.00
Rate for Payer: Health Management Network Commercial	$2,805.00
Rate for Payer: Kaiser Permanente Commercial	$2,970.00
Rate for Payer: MDX Hawaii PPO	$3,201.00
Rate for Payer: University Health Alliance Commercial	$1,848.00

KNEE SZH 9MM 42-5182-008-09

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,444.40
Rate for Payer: AlohaCare Medicaid	$1,260.00
Rate for Payer: AlohaCare Medicare	$1,915.20
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Devoted Health Medicare	$2,116.80
Rate for Payer: Hawaii Medical Service Association Medicare	$1,915.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Humana Medicare	$1,915.20
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: Kaiser Permanente Medicaid	$1,285.20
Rate for Payer: Kaiser Permanente Medicare	$1,915.20
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: Ohana Health Plan Medicaid	$1,915.20
Rate for Payer: Ohana Health Plan Medicare	$1,915.20
Rate for Payer: UnitedHealthcare Medicare	$1,915.20
Rate for Payer: University Health Alliance Commercial	$1,411.20

KNEE SZH 9MM 42-5182-008-09

Facility

$2,520.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,411.20
Max. Negotiated Rate	$2,444.40
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,764.00
Rate for Payer: Health Management Network Commercial	$2,142.00
Rate for Payer: Kaiser Permanente Commercial	$2,268.00
Rate for Payer: MDX Hawaii PPO	$2,444.40
Rate for Payer: University Health Alliance Commercial	$1,411.20

KNEE TIB SZ:3 00-5842-003-01

Facility

$2,861.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,430.50
Max. Negotiated Rate	$2,775.17
Rate for Payer: AlohaCare Medicaid	$1,430.50
Rate for Payer: AlohaCare Medicare	$2,174.36
Rate for Payer: Cash Price	$1,716.60
Rate for Payer: Devoted Health Medicare	$2,403.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,174.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,002.70
Rate for Payer: Health Management Network Commercial	$2,431.85
Rate for Payer: Humana Medicare	$2,174.36
Rate for Payer: Kaiser Permanente Commercial	$2,574.90
Rate for Payer: Kaiser Permanente Medicaid	$1,459.11
Rate for Payer: Kaiser Permanente Medicare	$2,174.36
Rate for Payer: MDX Hawaii PPO	$2,775.17
Rate for Payer: Ohana Health Plan Medicaid	$2,174.36
Rate for Payer: Ohana Health Plan Medicare	$2,174.36
Rate for Payer: UnitedHealthcare Medicare	$2,174.36
Rate for Payer: University Health Alliance Commercial	$1,602.16

KNEE TIB SZ:3 00-5842-003-01

Facility

$2,861.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,602.16
Max. Negotiated Rate	$2,775.17
Rate for Payer: Cash Price	$1,716.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,002.70
Rate for Payer: Health Management Network Commercial	$2,431.85
Rate for Payer: Kaiser Permanente Commercial	$2,574.90
Rate for Payer: MDX Hawaii PPO	$2,775.17
Rate for Payer: University Health Alliance Commercial	$1,602.16

KNEE TIB SZ:5 00-5842-005-01

Facility

$4,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,363.20
Max. Negotiated Rate	$4,093.40
Rate for Payer: Cash Price	$2,532.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,954.00
Rate for Payer: Health Management Network Commercial	$3,587.00
Rate for Payer: Kaiser Permanente Commercial	$3,798.00
Rate for Payer: MDX Hawaii PPO	$4,093.40
Rate for Payer: University Health Alliance Commercial	$2,363.20

KNEE TIB SZ:5 00-5842-005-01

Facility

$4,220.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,110.00
Max. Negotiated Rate	$4,093.40
Rate for Payer: AlohaCare Medicaid	$2,110.00
Rate for Payer: AlohaCare Medicare	$3,207.20
Rate for Payer: Cash Price	$2,532.00
Rate for Payer: Devoted Health Medicare	$3,544.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,207.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,954.00
Rate for Payer: Health Management Network Commercial	$3,587.00
Rate for Payer: Humana Medicare	$3,207.20
Rate for Payer: Kaiser Permanente Commercial	$3,798.00
Rate for Payer: Kaiser Permanente Medicaid	$2,152.20
Rate for Payer: Kaiser Permanente Medicare	$3,207.20
Rate for Payer: MDX Hawaii PPO	$4,093.40
Rate for Payer: Ohana Health Plan Medicaid	$3,207.20
Rate for Payer: Ohana Health Plan Medicare	$3,207.20
Rate for Payer: UnitedHealthcare Medicare	$3,207.20
Rate for Payer: University Health Alliance Commercial	$2,363.20

KNE FEM SZ:D/LT 00-5956-014-01

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

KNE FEM SZ:D/LT 00-5956-014-01

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

KNE FEM SZ:E 00-5842-015-01

Facility

$6,976.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,488.00
Max. Negotiated Rate	$6,766.72
Rate for Payer: AlohaCare Medicaid	$3,488.00
Rate for Payer: AlohaCare Medicare	$5,301.76
Rate for Payer: Cash Price	$4,185.60
Rate for Payer: Devoted Health Medicare	$5,859.84
Rate for Payer: Hawaii Medical Service Association Medicare	$5,301.76
Rate for Payer: Hawaii Western Management Group Commercial	$4,883.20
Rate for Payer: Health Management Network Commercial	$5,929.60
Rate for Payer: Humana Medicare	$5,301.76
Rate for Payer: Kaiser Permanente Commercial	$6,278.40
Rate for Payer: Kaiser Permanente Medicaid	$3,557.76
Rate for Payer: Kaiser Permanente Medicare	$5,301.76
Rate for Payer: MDX Hawaii PPO	$6,766.72
Rate for Payer: Ohana Health Plan Medicaid	$5,301.76
Rate for Payer: Ohana Health Plan Medicare	$5,301.76
Rate for Payer: UnitedHealthcare Medicare	$5,301.76
Rate for Payer: University Health Alliance Commercial	$3,906.56

KNE FEM SZ:E 00-5842-015-01

Facility

$6,976.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,906.56
Max. Negotiated Rate	$6,766.72
Rate for Payer: Cash Price	$4,185.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,883.20
Rate for Payer: Health Management Network Commercial	$5,929.60
Rate for Payer: Kaiser Permanente Commercial	$6,278.40
Rate for Payer: MDX Hawaii PPO	$6,766.72
Rate for Payer: University Health Alliance Commercial	$3,906.56

KNE FEM SZ:E/LT 00-5750-015-01

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

KNE FEM SZ:E/LT 00-5750-015-01

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

KNE FEM SZ:E/LT 00-5956-015-01

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

Know your out-of-pocket cost for care.

All Charges