Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NEXGEN CR-FLEX #90-5970-021-14

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX #90-5970-021-14

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.50
Max. Negotiated Rate	$2,408.51
Rate for Payer: AlohaCare Medicaid	$1,241.50
Rate for Payer: AlohaCare Medicare	$1,887.08
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Devoted Health Medicare	$2,085.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Humana Medicare	$1,887.08
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: Kaiser Permanente Medicare	$1,887.08
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: Ohana Health Plan Medicaid	$1,887.08
Rate for Payer: Ohana Health Plan Medicare	$1,887.08
Rate for Payer: UnitedHealthcare Medicare	$1,887.08
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.50
Max. Negotiated Rate	$2,408.51
Rate for Payer: AlohaCare Medicaid	$1,241.50
Rate for Payer: AlohaCare Medicare	$1,887.08
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Devoted Health Medicare	$2,085.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Humana Medicare	$1,887.08
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: Kaiser Permanente Medicare	$1,887.08
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: Ohana Health Plan Medicaid	$1,887.08
Rate for Payer: Ohana Health Plan Medicare	$1,887.08
Rate for Payer: UnitedHealthcare Medicare	$1,887.08
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF, 14MM

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF, 14MM

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.50
Max. Negotiated Rate	$2,408.51
Rate for Payer: AlohaCare Medicaid	$1,241.50
Rate for Payer: AlohaCare Medicare	$1,887.08
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Devoted Health Medicare	$2,085.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Humana Medicare	$1,887.08
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: Kaiser Permanente Medicare	$1,887.08
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: Ohana Health Plan Medicaid	$1,887.08
Rate for Payer: Ohana Health Plan Medicare	$1,887.08
Rate for Payer: UnitedHealthcare Medicare	$1,887.08
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF BLUE

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF BLUE

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.50
Max. Negotiated Rate	$2,408.51
Rate for Payer: AlohaCare Medicaid	$1,241.50
Rate for Payer: AlohaCare Medicare	$1,887.08
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Devoted Health Medicare	$2,085.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Humana Medicare	$1,887.08
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: Kaiser Permanente Medicare	$1,887.08
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: Ohana Health Plan Medicaid	$1,887.08
Rate for Payer: Ohana Health Plan Medicare	$1,887.08
Rate for Payer: UnitedHealthcare Medicare	$1,887.08
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF YELLOW

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.50
Max. Negotiated Rate	$2,408.51
Rate for Payer: AlohaCare Medicaid	$1,241.50
Rate for Payer: AlohaCare Medicare	$1,887.08
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Devoted Health Medicare	$2,085.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Humana Medicare	$1,887.08
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: Kaiser Permanente Medicare	$1,887.08
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: Ohana Health Plan Medicaid	$1,887.08
Rate for Payer: Ohana Health Plan Medicare	$1,887.08
Rate for Payer: UnitedHealthcare Medicare	$1,887.08
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF YELLOW

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF YLW 10

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX ART SURF YLW 10

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.50
Max. Negotiated Rate	$2,408.51
Rate for Payer: AlohaCare Medicaid	$1,241.50
Rate for Payer: AlohaCare Medicare	$1,887.08
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Devoted Health Medicare	$2,085.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Humana Medicare	$1,887.08
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: Kaiser Permanente Medicare	$1,887.08
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: Ohana Health Plan Medicaid	$1,887.08
Rate for Payer: Ohana Health Plan Medicare	$1,887.08
Rate for Payer: UnitedHealthcare Medicare	$1,887.08
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN CR-FLEX OPT FEM, C-LT

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

NEXGEN CR-FLEX OPT FEM, C-LT

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

NEXGEN CR-FLEX OPT FEM, E-LT

Facility

$7,795.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,897.50
Max. Negotiated Rate	$7,561.15
Rate for Payer: AlohaCare Medicaid	$3,897.50
Rate for Payer: AlohaCare Medicare	$5,924.20
Rate for Payer: Cash Price	$4,677.00
Rate for Payer: Devoted Health Medicare	$6,547.80
Rate for Payer: Hawaii Medical Service Association Medicare	$5,924.20
Rate for Payer: Hawaii Western Management Group Commercial	$5,456.50
Rate for Payer: Health Management Network Commercial	$6,625.75
Rate for Payer: Humana Medicare	$5,924.20
Rate for Payer: Kaiser Permanente Commercial	$7,015.50
Rate for Payer: Kaiser Permanente Medicaid	$3,975.45
Rate for Payer: Kaiser Permanente Medicare	$5,924.20
Rate for Payer: MDX Hawaii PPO	$7,561.15
Rate for Payer: Ohana Health Plan Medicaid	$5,924.20
Rate for Payer: Ohana Health Plan Medicare	$5,924.20
Rate for Payer: UnitedHealthcare Medicare	$5,924.20
Rate for Payer: University Health Alliance Commercial	$4,365.20

NEXGEN CR-FLEX OPT FEM, E-LT

Facility

$7,795.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,365.20
Max. Negotiated Rate	$7,561.15
Rate for Payer: Cash Price	$4,677.00
Rate for Payer: Hawaii Western Management Group Commercial	$5,456.50
Rate for Payer: Health Management Network Commercial	$6,625.75
Rate for Payer: Kaiser Permanente Commercial	$7,015.50
Rate for Payer: MDX Hawaii PPO	$7,561.15
Rate for Payer: University Health Alliance Commercial	$4,365.20

NEXGEN CR-FLEX OPTION FEMORAL

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

NEXGEN CR-FLEX OPTION FEMORAL

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

NEXGEN FLEX ART SURF BLU,10M

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,241.50
Max. Negotiated Rate	$2,408.51
Rate for Payer: AlohaCare Medicaid	$1,241.50
Rate for Payer: AlohaCare Medicare	$1,887.08
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Devoted Health Medicare	$2,085.72
Rate for Payer: Hawaii Medical Service Association Medicare	$1,887.08
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Humana Medicare	$1,887.08
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: Kaiser Permanente Medicaid	$1,266.33
Rate for Payer: Kaiser Permanente Medicare	$1,887.08
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: Ohana Health Plan Medicaid	$1,887.08
Rate for Payer: Ohana Health Plan Medicare	$1,887.08
Rate for Payer: UnitedHealthcare Medicare	$1,887.08
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN FLEX ART SURF BLU,10M

Facility

$2,483.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,390.48
Max. Negotiated Rate	$2,408.51
Rate for Payer: Cash Price	$1,489.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,738.10
Rate for Payer: Health Management Network Commercial	$2,110.55
Rate for Payer: Kaiser Permanente Commercial	$2,234.70
Rate for Payer: MDX Hawaii PPO	$2,408.51
Rate for Payer: University Health Alliance Commercial	$1,390.48

NEXGEN LCCK 20MM 5994-22-20

Facility

$4,213.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,106.50
Max. Negotiated Rate	$4,086.61
Rate for Payer: AlohaCare Medicaid	$2,106.50
Rate for Payer: AlohaCare Medicare	$3,201.88
Rate for Payer: Cash Price	$2,527.80
Rate for Payer: Devoted Health Medicare	$3,538.92
Rate for Payer: Hawaii Medical Service Association Medicare	$3,201.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.10
Rate for Payer: Health Management Network Commercial	$3,581.05
Rate for Payer: Humana Medicare	$3,201.88
Rate for Payer: Kaiser Permanente Commercial	$3,791.70
Rate for Payer: Kaiser Permanente Medicaid	$2,148.63
Rate for Payer: Kaiser Permanente Medicare	$3,201.88
Rate for Payer: MDX Hawaii PPO	$4,086.61
Rate for Payer: Ohana Health Plan Medicaid	$3,201.88
Rate for Payer: Ohana Health Plan Medicare	$3,201.88
Rate for Payer: UnitedHealthcare Medicare	$3,201.88
Rate for Payer: University Health Alliance Commercial	$2,359.28

NEXGEN LCCK 20MM 5994-22-20

Facility

$4,213.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,359.28
Max. Negotiated Rate	$4,086.61
Rate for Payer: Cash Price	$2,527.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,949.10
Rate for Payer: Health Management Network Commercial	$3,581.05
Rate for Payer: Kaiser Permanente Commercial	$3,791.70
Rate for Payer: MDX Hawaii PPO	$4,086.61
Rate for Payer: University Health Alliance Commercial	$2,359.28

NEXGEN LCCK SZ C RT 5994-13-92

Facility

$12,114.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,783.84
Max. Negotiated Rate	$11,750.58
Rate for Payer: Cash Price	$7,268.40
Rate for Payer: Hawaii Western Management Group Commercial	$8,479.80
Rate for Payer: Health Management Network Commercial	$10,296.90
Rate for Payer: Kaiser Permanente Commercial	$10,902.60
Rate for Payer: MDX Hawaii PPO	$11,750.58
Rate for Payer: University Health Alliance Commercial	$6,783.84

NEXGEN LCCK SZ C RT 5994-13-92

Facility

$12,114.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$6,057.00
Max. Negotiated Rate	$11,750.58
Rate for Payer: AlohaCare Medicaid	$6,057.00
Rate for Payer: AlohaCare Medicare	$9,206.64
Rate for Payer: Cash Price	$7,268.40
Rate for Payer: Devoted Health Medicare	$10,175.76
Rate for Payer: Hawaii Medical Service Association Medicare	$9,206.64
Rate for Payer: Hawaii Western Management Group Commercial	$8,479.80
Rate for Payer: Health Management Network Commercial	$10,296.90
Rate for Payer: Humana Medicare	$9,206.64
Rate for Payer: Kaiser Permanente Commercial	$10,902.60
Rate for Payer: Kaiser Permanente Medicaid	$6,178.14
Rate for Payer: Kaiser Permanente Medicare	$9,206.64
Rate for Payer: MDX Hawaii PPO	$11,750.58
Rate for Payer: Ohana Health Plan Medicaid	$9,206.64
Rate for Payer: Ohana Health Plan Medicare	$9,206.64
Rate for Payer: UnitedHealthcare Medicare	$9,206.64
Rate for Payer: University Health Alliance Commercial	$6,783.84

NEXGEN LPS-FLEX 00-5964-022-10

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,401.50
Max. Negotiated Rate	$2,718.91
Rate for Payer: AlohaCare Medicaid	$1,401.50
Rate for Payer: AlohaCare Medicare	$2,130.28
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Devoted Health Medicare	$2,354.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,130.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: Humana Medicare	$2,130.28
Rate for Payer: Kaiser Permanente Commercial	$2,522.70
Rate for Payer: Kaiser Permanente Medicaid	$1,429.53
Rate for Payer: Kaiser Permanente Medicare	$2,130.28
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: Ohana Health Plan Medicaid	$2,130.28
Rate for Payer: Ohana Health Plan Medicare	$2,130.28
Rate for Payer: UnitedHealthcare Medicare	$2,130.28
Rate for Payer: University Health Alliance Commercial	$1,569.68

Know your out-of-pocket cost for care.

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