Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

TRI CR FEM CEMENT #5510-F-802

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRI CR FEM CEMENT #5515-F-401

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRI CR FEM CEMENT #5515-F-401

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRI CR FEM CEMENT #5515-F-601

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,141.00
Max. Negotiated Rate	$4,153.54
Rate for Payer: AlohaCare Medicaid	$2,141.00
Rate for Payer: AlohaCare Medicare	$3,254.32
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Devoted Health Medicare	$3,596.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,254.32
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Humana Medicare	$3,254.32
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: Kaiser Permanente Medicaid	$2,183.82
Rate for Payer: Kaiser Permanente Medicare	$3,254.32
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: Ohana Health Plan Medicaid	$3,254.32
Rate for Payer: Ohana Health Plan Medicare	$3,254.32
Rate for Payer: UnitedHealthcare Medicare	$3,254.32
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRI CR FEM CEMENT #5515-F-601

Facility

$4,282.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$2,397.92
Max. Negotiated Rate	$4,153.54
Rate for Payer: Cash Price	$2,569.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,997.40
Rate for Payer: Health Management Network Commercial	$3,639.70
Rate for Payer: Kaiser Permanente Commercial	$3,853.80
Rate for Payer: MDX Hawaii PPO	$4,153.54
Rate for Payer: University Health Alliance Commercial	$2,397.92

TRI CR XS TIB INSRT 5530-G-311

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,786.72
Max. Negotiated Rate	$6,559.14
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-311

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,381.00
Max. Negotiated Rate	$6,559.14
Rate for Payer: AlohaCare Medicaid	$3,381.00
Rate for Payer: AlohaCare Medicare	$5,139.12
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Devoted Health Medicare	$5,680.08
Rate for Payer: Hawaii Medical Service Association Medicare	$5,139.12
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Humana Medicare	$5,139.12
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: Kaiser Permanente Medicaid	$3,448.62
Rate for Payer: Kaiser Permanente Medicare	$5,139.12
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: Ohana Health Plan Medicaid	$5,139.12
Rate for Payer: Ohana Health Plan Medicare	$5,139.12
Rate for Payer: UnitedHealthcare Medicare	$5,139.12
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-313

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,381.00
Max. Negotiated Rate	$6,559.14
Rate for Payer: AlohaCare Medicaid	$3,381.00
Rate for Payer: AlohaCare Medicare	$5,139.12
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Devoted Health Medicare	$5,680.08
Rate for Payer: Hawaii Medical Service Association Medicare	$5,139.12
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Humana Medicare	$5,139.12
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: Kaiser Permanente Medicaid	$3,448.62
Rate for Payer: Kaiser Permanente Medicare	$5,139.12
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: Ohana Health Plan Medicaid	$5,139.12
Rate for Payer: Ohana Health Plan Medicare	$5,139.12
Rate for Payer: UnitedHealthcare Medicare	$5,139.12
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-313

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,786.72
Max. Negotiated Rate	$6,559.14
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-409

Facility

$7,316.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$4,096.96
Max. Negotiated Rate	$7,096.52
Rate for Payer: Cash Price	$4,389.60
Rate for Payer: Hawaii Western Management Group Commercial	$5,121.20
Rate for Payer: Health Management Network Commercial	$6,218.60
Rate for Payer: Kaiser Permanente Commercial	$6,584.40
Rate for Payer: MDX Hawaii PPO	$7,096.52
Rate for Payer: University Health Alliance Commercial	$4,096.96

TRI CR XS TIB INSRT 5530-G-409

Facility

$7,316.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,658.00
Max. Negotiated Rate	$7,096.52
Rate for Payer: AlohaCare Medicaid	$3,658.00
Rate for Payer: AlohaCare Medicare	$5,560.16
Rate for Payer: Cash Price	$4,389.60
Rate for Payer: Devoted Health Medicare	$6,145.44
Rate for Payer: Hawaii Medical Service Association Medicare	$5,560.16
Rate for Payer: Hawaii Western Management Group Commercial	$5,121.20
Rate for Payer: Health Management Network Commercial	$6,218.60
Rate for Payer: Humana Medicare	$5,560.16
Rate for Payer: Kaiser Permanente Commercial	$6,584.40
Rate for Payer: Kaiser Permanente Medicaid	$3,731.16
Rate for Payer: Kaiser Permanente Medicare	$5,560.16
Rate for Payer: MDX Hawaii PPO	$7,096.52
Rate for Payer: Ohana Health Plan Medicaid	$5,560.16
Rate for Payer: Ohana Health Plan Medicare	$5,560.16
Rate for Payer: UnitedHealthcare Medicare	$5,560.16
Rate for Payer: University Health Alliance Commercial	$4,096.96

TRI CR XS TIB INSRT 5530-G-411

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,381.00
Max. Negotiated Rate	$6,559.14
Rate for Payer: AlohaCare Medicaid	$3,381.00
Rate for Payer: AlohaCare Medicare	$5,139.12
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Devoted Health Medicare	$5,680.08
Rate for Payer: Hawaii Medical Service Association Medicare	$5,139.12
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Humana Medicare	$5,139.12
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: Kaiser Permanente Medicaid	$3,448.62
Rate for Payer: Kaiser Permanente Medicare	$5,139.12
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: Ohana Health Plan Medicaid	$5,139.12
Rate for Payer: Ohana Health Plan Medicare	$5,139.12
Rate for Payer: UnitedHealthcare Medicare	$5,139.12
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-411

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,786.72
Max. Negotiated Rate	$6,559.14
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-509

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

TRI CR XS TIB INSRT 5530-G-509

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

TRI CR XS TIB INSRT 5530-G-511

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,381.00
Max. Negotiated Rate	$6,559.14
Rate for Payer: AlohaCare Medicaid	$3,381.00
Rate for Payer: AlohaCare Medicare	$5,139.12
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Devoted Health Medicare	$5,680.08
Rate for Payer: Hawaii Medical Service Association Medicare	$5,139.12
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Humana Medicare	$5,139.12
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: Kaiser Permanente Medicaid	$3,448.62
Rate for Payer: Kaiser Permanente Medicare	$5,139.12
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: Ohana Health Plan Medicaid	$5,139.12
Rate for Payer: Ohana Health Plan Medicare	$5,139.12
Rate for Payer: UnitedHealthcare Medicare	$5,139.12
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-511

Facility

$6,762.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,786.72
Max. Negotiated Rate	$6,559.14
Rate for Payer: Cash Price	$4,057.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,733.40
Rate for Payer: Health Management Network Commercial	$5,747.70
Rate for Payer: Kaiser Permanente Commercial	$6,085.80
Rate for Payer: MDX Hawaii PPO	$6,559.14
Rate for Payer: University Health Alliance Commercial	$3,786.72

TRI CR XS TIB INSRT 5530-G-609

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

TRI CR XS TIB INSRT 5530-G-609

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

TRI CR XS TIB INSRT 5530-G-611

Facility

$6,964.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,899.84
Max. Negotiated Rate	$6,755.08
Rate for Payer: Cash Price	$4,178.40
Rate for Payer: Hawaii Western Management Group Commercial	$4,874.80
Rate for Payer: Health Management Network Commercial	$5,919.40
Rate for Payer: Kaiser Permanente Commercial	$6,267.60
Rate for Payer: MDX Hawaii PPO	$6,755.08
Rate for Payer: University Health Alliance Commercial	$3,899.84

TRI CR XS TIB INSRT 5530-G-611

Facility

$6,964.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,482.00
Max. Negotiated Rate	$6,755.08
Rate for Payer: AlohaCare Medicaid	$3,482.00
Rate for Payer: AlohaCare Medicare	$5,292.64
Rate for Payer: Cash Price	$4,178.40
Rate for Payer: Devoted Health Medicare	$5,849.76
Rate for Payer: Hawaii Medical Service Association Medicare	$5,292.64
Rate for Payer: Hawaii Western Management Group Commercial	$4,874.80
Rate for Payer: Health Management Network Commercial	$5,919.40
Rate for Payer: Humana Medicare	$5,292.64
Rate for Payer: Kaiser Permanente Commercial	$6,267.60
Rate for Payer: Kaiser Permanente Medicaid	$3,551.64
Rate for Payer: Kaiser Permanente Medicare	$5,292.64
Rate for Payer: MDX Hawaii PPO	$6,755.08
Rate for Payer: Ohana Health Plan Medicaid	$5,292.64
Rate for Payer: Ohana Health Plan Medicare	$5,292.64
Rate for Payer: UnitedHealthcare Medicare	$5,292.64
Rate for Payer: University Health Alliance Commercial	$3,899.84

TRI CR XS TIB INSRT 5530-G-616

Facility

$6,616.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,308.00
Max. Negotiated Rate	$6,417.52
Rate for Payer: AlohaCare Medicaid	$3,308.00
Rate for Payer: AlohaCare Medicare	$5,028.16
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Devoted Health Medicare	$5,557.44
Rate for Payer: Hawaii Medical Service Association Medicare	$5,028.16
Rate for Payer: Hawaii Western Management Group Commercial	$4,631.20
Rate for Payer: Health Management Network Commercial	$5,623.60
Rate for Payer: Humana Medicare	$5,028.16
Rate for Payer: Kaiser Permanente Commercial	$5,954.40
Rate for Payer: Kaiser Permanente Medicaid	$3,374.16
Rate for Payer: Kaiser Permanente Medicare	$5,028.16
Rate for Payer: MDX Hawaii PPO	$6,417.52
Rate for Payer: Ohana Health Plan Medicaid	$5,028.16
Rate for Payer: Ohana Health Plan Medicare	$5,028.16
Rate for Payer: UnitedHealthcare Medicare	$5,028.16
Rate for Payer: University Health Alliance Commercial	$3,704.96

TRI CR XS TIB INSRT 5530-G-616

Facility

$6,616.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$3,704.96
Max. Negotiated Rate	$6,417.52
Rate for Payer: Cash Price	$3,969.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,631.20
Rate for Payer: Health Management Network Commercial	$5,623.60
Rate for Payer: Kaiser Permanente Commercial	$5,954.40
Rate for Payer: MDX Hawaii PPO	$6,417.52
Rate for Payer: University Health Alliance Commercial	$3,704.96

TRI CR XS TIB INSRT 5530-G-709

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,513.68
Max. Negotiated Rate	$2,621.91
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: University Health Alliance Commercial	$1,513.68

TRI CR XS TIB INSRT 5530-G-709

Facility

$2,703.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.50
Max. Negotiated Rate	$2,621.91
Rate for Payer: AlohaCare Medicaid	$1,351.50
Rate for Payer: AlohaCare Medicare	$2,054.28
Rate for Payer: Cash Price	$1,621.80
Rate for Payer: Devoted Health Medicare	$2,270.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,054.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,892.10
Rate for Payer: Health Management Network Commercial	$2,297.55
Rate for Payer: Humana Medicare	$2,054.28
Rate for Payer: Kaiser Permanente Commercial	$2,432.70
Rate for Payer: Kaiser Permanente Medicaid	$1,378.53
Rate for Payer: Kaiser Permanente Medicare	$2,054.28
Rate for Payer: MDX Hawaii PPO	$2,621.91
Rate for Payer: Ohana Health Plan Medicaid	$2,054.28
Rate for Payer: Ohana Health Plan Medicare	$2,054.28
Rate for Payer: UnitedHealthcare Medicare	$2,054.28
Rate for Payer: University Health Alliance Commercial	$1,513.68

Know your out-of-pocket cost for care.

All Charges