Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NEXGEN LPS-FLEX 00-5964-022-10

Facility

$2,803.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,569.68
Max. Negotiated Rate	$2,718.91
Rate for Payer: Cash Price	$1,681.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,962.10
Rate for Payer: Health Management Network Commercial	$2,382.55
Rate for Payer: Kaiser Permanente Commercial	$2,522.70
Rate for Payer: MDX Hawaii PPO	$2,718.91
Rate for Payer: University Health Alliance Commercial	$1,569.68

NEXGEN LPS FLEX PRECOAT FEM

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 LPS FLEX PRECOAT FEM

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 LPS FLEX TITANIUM FEM

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 LPS FLEX TITANIUM FEM

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 LPS FLEX TIVANIUM FEM

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 LPS FLEX TIVANIUM FEM

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 OFFST 12X100 5988-20-12

Facility

$2,921.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,460.50
Max. Negotiated Rate	$2,833.37
Rate for Payer: AlohaCare Medicaid	$1,460.50
Rate for Payer: AlohaCare Medicare	$2,219.96
Rate for Payer: Cash Price	$1,752.60
Rate for Payer: Devoted Health Medicare	$2,453.64
Rate for Payer: Hawaii Medical Service Association Medicare	$2,219.96
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.70
Rate for Payer: Health Management Network Commercial	$2,482.85
Rate for Payer: Humana Medicare	$2,219.96
Rate for Payer: Kaiser Permanente Commercial	$2,628.90
Rate for Payer: Kaiser Permanente Medicaid	$1,489.71
Rate for Payer: Kaiser Permanente Medicare	$2,219.96
Rate for Payer: MDX Hawaii PPO	$2,833.37
Rate for Payer: Ohana Health Plan Medicaid	$2,219.96
Rate for Payer: Ohana Health Plan Medicare	$2,219.96
Rate for Payer: UnitedHealthcare Medicare	$2,219.96
Rate for Payer: University Health Alliance Commercial	$1,635.76

NEXGEN OFFST 12X100 5988-20-12

Facility

$2,921.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.76
Max. Negotiated Rate	$2,833.37
Rate for Payer: Cash Price	$1,752.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,044.70
Rate for Payer: Health Management Network Commercial	$2,482.85
Rate for Payer: Kaiser Permanente Commercial	$2,628.90
Rate for Payer: MDX Hawaii PPO	$2,833.37
Rate for Payer: University Health Alliance Commercial	$1,635.76

NEX GEN PATELLA 00-5972-065-38

Facility

$2,323.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,161.50
Max. Negotiated Rate	$2,253.31
Rate for Payer: AlohaCare Medicaid	$1,161.50
Rate for Payer: AlohaCare Medicare	$1,765.48
Rate for Payer: Cash Price	$1,393.80
Rate for Payer: Devoted Health Medicare	$1,951.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,765.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,626.10
Rate for Payer: Health Management Network Commercial	$1,974.55
Rate for Payer: Humana Medicare	$1,765.48
Rate for Payer: Kaiser Permanente Commercial	$2,090.70
Rate for Payer: Kaiser Permanente Medicaid	$1,184.73
Rate for Payer: Kaiser Permanente Medicare	$1,765.48
Rate for Payer: MDX Hawaii PPO	$2,253.31
Rate for Payer: Ohana Health Plan Medicaid	$1,765.48
Rate for Payer: Ohana Health Plan Medicare	$1,765.48
Rate for Payer: UnitedHealthcare Medicare	$1,765.48
Rate for Payer: University Health Alliance Commercial	$1,300.88

NEX GEN PATELLA 00-5972-065-38

Facility

$2,323.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.88
Max. Negotiated Rate	$2,253.31
Rate for Payer: Cash Price	$1,393.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,626.10
Rate for Payer: Health Management Network Commercial	$1,974.55
Rate for Payer: Kaiser Permanente Commercial	$2,090.70
Rate for Payer: MDX Hawaii PPO	$2,253.31
Rate for Payer: University Health Alliance Commercial	$1,300.88

NEXGEN TAPER PLUG

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

NEXGEN TAPER PLUG

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

NEXGEN TIB AUGMENT BLCK 5M, 6

Facility

$2,240.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.40
Max. Negotiated Rate	$2,172.80
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,568.00
Rate for Payer: Health Management Network Commercial	$1,904.00
Rate for Payer: Kaiser Permanente Commercial	$2,016.00
Rate for Payer: MDX Hawaii PPO	$2,172.80
Rate for Payer: University Health Alliance Commercial	$1,254.40

NEXGEN TIB AUGMENT BLCK 5M, 6

Facility

$2,240.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$2,172.80
Rate for Payer: AlohaCare Medicaid	$1,120.00
Rate for Payer: AlohaCare Medicare	$1,702.40
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Devoted Health Medicare	$1,881.60
Rate for Payer: Hawaii Medical Service Association Medicare	$1,702.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,568.00
Rate for Payer: Health Management Network Commercial	$1,904.00
Rate for Payer: Humana Medicare	$1,702.40
Rate for Payer: Kaiser Permanente Commercial	$2,016.00
Rate for Payer: Kaiser Permanente Medicaid	$1,142.40
Rate for Payer: Kaiser Permanente Medicare	$1,702.40
Rate for Payer: MDX Hawaii PPO	$2,172.80
Rate for Payer: Ohana Health Plan Medicaid	$1,702.40
Rate for Payer: Ohana Health Plan Medicare	$1,702.40
Rate for Payer: UnitedHealthcare Medicare	$1,702.40
Rate for Payer: University Health Alliance Commercial	$1,254.40

NEXGEN TIBIAL SZ 2 5980-27-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$1,976.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$2,184.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,976.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$1,976.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$1,976.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$1,976.00
Rate for Payer: Ohana Health Plan Medicare	$1,976.00
Rate for Payer: UnitedHealthcare Medicare	$1,976.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEXGEN TIBIAL SZ 2 5980-27-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEX KNE 3-4 12M 90-5970-030-12

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

NEX KNE 3-4 12M 90-5970-030-12

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

NEX TIB PL SZ:3 00-5980-037-01

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,112.00
Max. Negotiated Rate	$4,097.28
Rate for Payer: AlohaCare Medicaid	$2,112.00
Rate for Payer: AlohaCare Medicare	$3,210.24
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Devoted Health Medicare	$3,548.16
Rate for Payer: Hawaii Medical Service Association Medicare	$3,210.24
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Humana Medicare	$3,210.24
Rate for Payer: Kaiser Permanente Commercial	$3,801.60
Rate for Payer: Kaiser Permanente Medicaid	$2,154.24
Rate for Payer: Kaiser Permanente Medicare	$3,210.24
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: Ohana Health Plan Medicaid	$3,210.24
Rate for Payer: Ohana Health Plan Medicare	$3,210.24
Rate for Payer: UnitedHealthcare Medicare	$3,210.24
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:3 00-5980-037-01

Facility

$4,224.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.44
Max. Negotiated Rate	$4,097.28
Rate for Payer: Cash Price	$2,534.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,956.80
Rate for Payer: Health Management Network Commercial	$3,590.40
Rate for Payer: Kaiser Permanente Commercial	$3,801.60
Rate for Payer: MDX Hawaii PPO	$4,097.28
Rate for Payer: University Health Alliance Commercial	$2,365.44

NEX TIB PL SZ:4 00-5980-037-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEX TIB PL SZ:4 00-5980-037-02

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$1,976.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$2,184.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,976.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$1,976.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$1,976.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$1,976.00
Rate for Payer: Ohana Health Plan Medicare	$1,976.00
Rate for Payer: UnitedHealthcare Medicare	$1,976.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEX TIB PL SZ:5 00-5980-047-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

NEX TIB PL SZ:5 00-5980-047-01

Facility

$2,600.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,300.00
Max. Negotiated Rate	$2,522.00
Rate for Payer: AlohaCare Medicaid	$1,300.00
Rate for Payer: AlohaCare Medicare	$1,976.00
Rate for Payer: Cash Price	$1,560.00
Rate for Payer: Devoted Health Medicare	$2,184.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,976.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,820.00
Rate for Payer: Health Management Network Commercial	$2,210.00
Rate for Payer: Humana Medicare	$1,976.00
Rate for Payer: Kaiser Permanente Commercial	$2,340.00
Rate for Payer: Kaiser Permanente Medicaid	$1,326.00
Rate for Payer: Kaiser Permanente Medicare	$1,976.00
Rate for Payer: MDX Hawaii PPO	$2,522.00
Rate for Payer: Ohana Health Plan Medicaid	$1,976.00
Rate for Payer: Ohana Health Plan Medicare	$1,976.00
Rate for Payer: UnitedHealthcare Medicare	$1,976.00
Rate for Payer: University Health Alliance Commercial	$1,456.00

Know your out-of-pocket cost for care.

All Charges