Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

OXF ANAT BRG LT LG5 PMA 159556

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,324.50
Max. Negotiated Rate	$2,569.53
Rate for Payer: AlohaCare Medicaid	$1,324.50
Rate for Payer: AlohaCare Medicare	$2,013.24
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Devoted Health Medicare	$2,225.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,013.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Humana Medicare	$2,013.24
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: Kaiser Permanente Medicaid	$1,350.99
Rate for Payer: Kaiser Permanente Medicare	$2,013.24
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: Ohana Health Plan Medicaid	$2,013.24
Rate for Payer: Ohana Health Plan Medicare	$2,013.24
Rate for Payer: UnitedHealthcare Medicare	$2,013.24
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXF ANAT BRG LT LG5 PMA 159556

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.44
Max. Negotiated Rate	$2,569.53
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXF ANAT BRG RT LG SZ9 159588

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

OXF ANAT BRG RT LG SZ9 159588

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

OXFANAT BRG RT MD SZ 6 159578

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFANAT BRG RT MD SZ 6 159578

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXF ANAT BRG RT SM3 PMA 159568

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,596.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: University Health Alliance Commercial	$1,596.00

OXF ANAT BRG RT SM3 PMA 159568

Facility

$2,850.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,425.00
Max. Negotiated Rate	$2,764.50
Rate for Payer: AlohaCare Medicaid	$1,425.00
Rate for Payer: AlohaCare Medicare	$2,166.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Devoted Health Medicare	$2,394.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,166.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,995.00
Rate for Payer: Health Management Network Commercial	$2,422.50
Rate for Payer: Humana Medicare	$2,166.00
Rate for Payer: Kaiser Permanente Commercial	$2,565.00
Rate for Payer: Kaiser Permanente Medicaid	$1,453.50
Rate for Payer: Kaiser Permanente Medicare	$2,166.00
Rate for Payer: MDX Hawaii PPO	$2,764.50
Rate for Payer: Ohana Health Plan Medicaid	$2,166.00
Rate for Payer: Ohana Health Plan Medicare	$2,166.00
Rate for Payer: UnitedHealthcare Medicare	$2,166.00
Rate for Payer: University Health Alliance Commercial	$1,596.00

OXFORD ANAT BRG RT LG SZ3

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD ANAT BRG RT LG SZ3

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD BEARING LT MD 6MM

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,324.50
Max. Negotiated Rate	$2,569.53
Rate for Payer: AlohaCare Medicaid	$1,324.50
Rate for Payer: AlohaCare Medicare	$2,013.24
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Devoted Health Medicare	$2,225.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,013.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Humana Medicare	$2,013.24
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: Kaiser Permanente Medicaid	$1,350.99
Rate for Payer: Kaiser Permanente Medicare	$2,013.24
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: Ohana Health Plan Medicaid	$2,013.24
Rate for Payer: Ohana Health Plan Medicare	$2,013.24
Rate for Payer: UnitedHealthcare Medicare	$2,013.24
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXFORD BEARING LT MD 6MM

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.44
Max. Negotiated Rate	$2,569.53
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXFORD BEARING MD 3MM #159575

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD BEARING MD 3MM #159575

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD BEARING MD 4MM #159576

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD BEARING MD 4MM #159576

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD BEARING MED LEFT 7MM

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,324.50
Max. Negotiated Rate	$2,569.53
Rate for Payer: AlohaCare Medicaid	$1,324.50
Rate for Payer: AlohaCare Medicare	$2,013.24
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Devoted Health Medicare	$2,225.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,013.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Humana Medicare	$2,013.24
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: Kaiser Permanente Medicaid	$1,350.99
Rate for Payer: Kaiser Permanente Medicare	$2,013.24
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: Ohana Health Plan Medicaid	$2,013.24
Rate for Payer: Ohana Health Plan Medicare	$2,013.24
Rate for Payer: UnitedHealthcare Medicare	$2,013.24
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXFORD BEARING MED LEFT 7MM

Facility

$2,649.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.44
Max. Negotiated Rate	$2,569.53
Rate for Payer: Cash Price	$1,589.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,854.30
Rate for Payer: Health Management Network Commercial	$2,251.65
Rate for Payer: Kaiser Permanente Commercial	$2,384.10
Rate for Payer: MDX Hawaii PPO	$2,569.53
Rate for Payer: University Health Alliance Commercial	$1,483.44

OXFORD BEARING PMA SZ5 159549

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD BEARING PMA SZ5 159549

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

OXFORD FEM LG TWIN-PEG 161470

Facility

$3,340.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,670.00
Max. Negotiated Rate	$3,239.80
Rate for Payer: AlohaCare Medicaid	$1,670.00
Rate for Payer: AlohaCare Medicare	$2,538.40
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Devoted Health Medicare	$2,805.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,538.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,338.00
Rate for Payer: Health Management Network Commercial	$2,839.00
Rate for Payer: Humana Medicare	$2,538.40
Rate for Payer: Kaiser Permanente Commercial	$3,006.00
Rate for Payer: Kaiser Permanente Medicaid	$1,703.40
Rate for Payer: Kaiser Permanente Medicare	$2,538.40
Rate for Payer: MDX Hawaii PPO	$3,239.80
Rate for Payer: Ohana Health Plan Medicaid	$2,538.40
Rate for Payer: Ohana Health Plan Medicare	$2,538.40
Rate for Payer: UnitedHealthcare Medicare	$2,538.40
Rate for Payer: University Health Alliance Commercial	$1,870.40

OXFORD FEM LG TWIN-PEG 161470

Facility

$3,340.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,870.40
Max. Negotiated Rate	$3,239.80
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,338.00
Rate for Payer: Health Management Network Commercial	$2,839.00
Rate for Payer: Kaiser Permanente Commercial	$3,006.00
Rate for Payer: MDX Hawaii PPO	$3,239.80
Rate for Payer: University Health Alliance Commercial	$1,870.40

OXFORD FEM MED TWIN-PEG 161469

Facility

$3,340.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,670.00
Max. Negotiated Rate	$3,239.80
Rate for Payer: AlohaCare Medicaid	$1,670.00
Rate for Payer: AlohaCare Medicare	$2,538.40
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Devoted Health Medicare	$2,805.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,538.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,338.00
Rate for Payer: Health Management Network Commercial	$2,839.00
Rate for Payer: Humana Medicare	$2,538.40
Rate for Payer: Kaiser Permanente Commercial	$3,006.00
Rate for Payer: Kaiser Permanente Medicaid	$1,703.40
Rate for Payer: Kaiser Permanente Medicare	$2,538.40
Rate for Payer: MDX Hawaii PPO	$3,239.80
Rate for Payer: Ohana Health Plan Medicaid	$2,538.40
Rate for Payer: Ohana Health Plan Medicare	$2,538.40
Rate for Payer: UnitedHealthcare Medicare	$2,538.40
Rate for Payer: University Health Alliance Commercial	$1,870.40

OXFORD FEM MED TWIN-PEG 161469

Facility

$3,340.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,870.40
Max. Negotiated Rate	$3,239.80
Rate for Payer: Cash Price	$2,004.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,338.00
Rate for Payer: Health Management Network Commercial	$2,839.00
Rate for Payer: Kaiser Permanente Commercial	$3,006.00
Rate for Payer: MDX Hawaii PPO	$3,239.80
Rate for Payer: University Health Alliance Commercial	$1,870.40

OXFORD FEMORAL LG TWIN PEG

Facility

$3,840.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,150.40
Max. Negotiated Rate	$3,724.80
Rate for Payer: Cash Price	$2,304.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,688.00
Rate for Payer: Health Management Network Commercial	$3,264.00
Rate for Payer: Kaiser Permanente Commercial	$3,456.00
Rate for Payer: MDX Hawaii PPO	$3,724.80
Rate for Payer: University Health Alliance Commercial	$2,150.40

Know your out-of-pocket cost for care.

All Charges