Hawaii Pacific Health · Lihue, HI
2 of 5
CMS star rating
72
Beds
2,907
Inpatient discharges a year
$156.3M
Net patient revenue a year
35
In-network payers
Wilcox Health is a 72-bed government - federal hospital in Lihue, HI, affiliated with Hawaii Pacific Health. Below you'll find publicly disclosed negotiated rates and facility details, including 35 in-network payers and 303 disclosed rate categories.
The 24 services Wilcox Health most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.
Book a demo to see hidden insurer names, more payer rates, and hospital data, or start a free trial.
Childbirth · Inpatient
MS-DRG 807
$10,304
negotiated rate
CMS lists this service as CPT 59400, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports neonatal nursery services to CMS
Childbirth · Inpatient
MS-DRG 788
$19,140
negotiated rate
CMS lists this service as CPT 59510, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 788, so these are facility case rates.
Hospital reports neonatal nursery services to CMS
Digestive procedures
CPT 45380
$806 - $4,765
from 3 insurers · median $3,883
Common here, based on CMS Medicare volume
Digestive procedures
CPT 43239
$806 - $4,765
from 3 insurers · median $3,883
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45385
$806 - $4,765
from 3 insurers · median $3,883
Common here, based on CMS Medicare volume
Orthopedics and pain
CPT 63030
$6,084 - $47,938
from 2 insurers · median $27,011
55 Medicare claims in Level 4 Musculoskeletal Procedures (CMS 2024)
CT imaging
CPT 74177
$181 - $2,787
from 4 insurers · median $447
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45378
$806 - $4,765
from 3 insurers · median $3,883
Common here, based on CMS Medicare volume
Cardiology and vascular testing
CPT 93306
$191 - $1,968
from 3 insurers · median $1,360
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 66984
$806 - $7,402
from 3 insurers · median $6,084
76 Medicare claims in Level 1 Intraocular Procedures (CMS 2024)
Medicine & Surgery
CPT 47562
$4,765 - $6,084
from 2 insurers · median $5,425
23 Medicare claims in Level 1 Laparoscopy and Related Services (CMS 2024)
Medicine & Surgery
CPT 49505
$5,484 - $7,402
from 2 insurers · median $6,443
11 Medicare claims in Level 1 Abdominal/Peritoneal/Biliary and Related Procedures (CMS 2024)
Gynecology
CPT 58571
$6,966 - $10,729
from 2 insurers · median $8,848
Typical for a hospital with this service line
Medicine & Surgery
CPT 29881
$5,484 - $7,402
from 2 insurers · median $6,443
29 Medicare claims in Level 3 Musculoskeletal Procedures (CMS 2024)
Mammography
CPT 77067
$87 - $310
from 4 insurers · median $139
Common here, based on CMS Medicare volume
Medicine & Surgery · Inpatient
MS-DRG 460
$85,481
negotiated rate
Hospital reports orthopedic surgery services to CMS
Gynecology
CPT 58558
$4,456 - $7,402
from 2 insurers · median $5,929
Typical for a hospital with this service line
Childbirth · Inpatient
MS-DRG 807
$10,304
negotiated rate
CMS lists this service as CPT 59610, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports neonatal nursery services to CMS
CT imaging
CPT 70450
$133 - $1,205
from 4 insurers · median $154
Common here, based on CMS Medicare volume
Ear, nose and throat
CPT 69436
$806 - $4,765
from 3 insurers · median $4,456
Typical for a hospital with this service line
Gynecology
CPT 58661
$6,084 - $10,729
from 2 insurers · median $8,407
Typical for a hospital with this service line
CT imaging
CPT 74176
$95 - $2,224
from 4 insurers · median $331
Common here, based on CMS Medicare volume
Orthopedics and pain
CPT 29848
$806 - $7,402
from 3 insurers · median $4,456
64 Medicare claims in Level 2 Musculoskeletal Procedures (CMS 2024)
CT imaging
CPT 71275
$321 - $1,958
from 4 insurers · median $390
Common here, based on CMS Medicare volume
Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.
| Insurer | Services | Median % of Medicare | Above nearby | Below nearby |
|---|---|---|---|---|
| Insurer A* | 6 | 847% | 0 | 0 |
| Insurer B* | 24 | 223% | 0 | 0 |
| Insurer C* | 20 | 157% | 0 | 0 |
| Insurer D* | 12 | 66% | 0 | 0 |
How we chose these services: 6 appear in this hospital's own Medicare claims, 10 are common here based on CMS Medicare volume, and 8 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for Wilcox Health, or start a free trial.
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.
Quality
2 of 5 stars
Doctors and services
Accredited by The Joint Commission
Finances
$156.3M net patient revenue
Ownership and leadership
Owned by Hawaii Pacific Health
The employer identification numbers (EINs) health plans and networks list for Wilcox Health in the in-network rate files they publish, with the organization NPIs billed under each.
| Tax ID (EIN) | Plans and networks listing it | Organization NPIs |
|---|---|---|
| 99-0074365Wilcox Memorial Hospital | 63Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Ambetter and 58 more | 1225113442 Wilcox Memorial Hospital1376957431 Wilcox Memorial Hospital Outpatient Pharmacy |
Source: PayerPrice analysis of insurers' Transparency in Coverage in-network files. An EIN can cover several hospitals and clinics in a health system, and insurers sometimes list other organizations' NPIs under it.
3-3420 Kuhio Highway, Lihue, HI 96766
(808) 245-1103
How Wilcox Health compares with other US facilities on the measures CMS publishes, mostly from Medicare patients.
Overall star rating
2 of 5
Lower than 73% of US hospitals
Combines death rates, safety, readmissions, patient experience and timely care
Death rates
No different on 4 measures
0 better, 4 no different, 0 worse than the US rate
Deaths within 30 days, such as after a heart attack, pneumonia or stroke
Safety
Better on 1 of 4 measures
1 better, 3 no different, 0 worse than the US rate
Infections, surgical complications and other harm in the hospital
Readmissions
Mixed on 7 measures
1 better, 5 no different, 1 worse than the US rate
Patients back in the hospital or ER soon after leaving
Patient survey rating
4 of 5
Higher than 60% of US hospitals
From the HCAHPS survey of recent inpatients
Would definitely recommend
70%
Lower than 53% of US hospitals
US median: 71%
Surveyed patients who would definitely recommend the hospital
Hospital-acquired condition penalty
Penalized
Among the worst-performing 25% of US hospitals
Medicare cuts payments 1% for the worst-performing 25% of hospitals on infections and injuries acquired in the hospital
Serious complications (PSI 90)
1.04
Higher than 72% of US hospitals
US median: 0.96
Risk-adjusted composite of complications such as bedsores, falls with hip fracture and blood clots after surgery; lower is better
Time in the ER before going home
156 min
Higher than 55% of US hospitals
US median: 148 min
Median minutes from arrival to leaving for ER patients who were sent home; lower is better
Sepsis care
81%
Higher than 86% of US hospitals
US median: 65%
Patients with severe sepsis or septic shock who got every step of the recommended early treatment; higher is better
| Measure | Result | Period |
|---|---|---|
| Overall star ratingCMS: Overall hospital quality star rating | 2 of 5 | |
| Death rates | No different on 4 measures | |
| Safety | Better on 1 of 4 measures | |
| Readmissions | Mixed on 7 measures | |
| Patient survey ratingCMS: Summary star rating | 4 of 5 | 2024-10-01 to 2025-09-30 |
| Would definitely recommendCMS: "YES", patients would definitely recommend the hospital | 70% | 2024-10-01 to 2025-09-30 |
| Hospital-acquired condition penaltyCMS: HAC Reduction Program payment reduction | Penalized | 2026 |
| Serious complications (PSI 90)CMS: Patient safety and adverse events composite (PSI 90) | 1.04 | 2022-07-01 to 2024-06-30 |
| Time in the ER before going homeCMS: Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better | 156 min | 2024-10-01 to 2025-09-30 |
| Sepsis careCMS: Appropriate care for severe sepsis and septic shock | 81% | 2024-10-01 to 2025-09-30 |
Source: CMS Provider Data Catalog, released 2026-08-13. US comparisons rank this facility among every facility CMS reports for each measure. See Medicare Care Compare.
How Medicare adjusts Wilcox Health's inpatient payments for its readmissions, quality and cost results.
-0.77% on Medicare payments
Readmissions penalty
Hospital Readmissions Reduction Program adjustment for excess readmissions, as estimated in the FY 2027 IPPS final rule.
+0.79% on Medicare payments
Value-based purchasing
Hospital Value-Based Purchasing bonus or reduction for quality and cost, as estimated in the FY 2027 IPPS final rule.
Source: CMS IPPS final rule Impact File (FY 2027).
Each result CMS publishes for Wilcox Health, beside the US median and the average of HI hospitals. The rank says what share of US hospitals the result is better or worse than; counts and confidence limits are not ranked.
Risk-adjusted 30-day death rates and surgical complications; lower is better.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Rate of complications for hip/knee replacement patients2023-04-01 to 2025-03-31 | Not Available | 4.2 | |||
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate2024-07-01 to 2025-06-30 · 774 cases | 3.6 | 3.9 | 3.677 | Better than 69% of US hospitals | |
| Death rate for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 11.4 | |||
| Death rate for CABG surgery patients2022-07-01 to 2025-06-30 | Not Available | 1.9 | |||
| Death rate for COPD patients2022-07-01 to 2025-06-30 | Not Available | 8.983 | |||
| Death rate for heart failure patients2022-07-01 to 2025-06-30 · 114 cases | 12.5 | 11 | 10.66 | Worse than 77% of US hospitals | |
| Death rate for pneumonia patients2022-07-01 to 2025-06-30 · 143 cases | 13.3 | 15.2 | 15.07 | Better than 78% of US hospitals | |
| Death rate for stroke patients2023-07-01 to 2025-06-30 · 111 cases | 11.2 | 11.6 | 10.71 | Better than 57% of US hospitals | |
| Pressure ulcer rate2022-07-01 to 2024-06-30 · 1,094 cases | 0.82 | 0.51 | 0.8555 | No Different Than the National Rate | Worse than 82% of US hospitals |
| Death rate among surgical inpatients with serious treatable complications2022-07-01 to 2024-06-30 | Not Available | 174 | Number of Cases Too Small | ||
| Iatrogenic pneumothorax rate2022-07-01 to 2024-06-30 · 1,440 cases | 0.2 | 0.2 | 0.2464 | No Different Than the National Rate | Better than 46% of US hospitals |
| In-hospital fall-associated fracture rate2022-07-01 to 2024-06-30 · 1,367 cases | 0.26 | 0.27 | 0.2773 | No Different Than the National Rate | Better than 54% of US hospitals |
| Postoperative hemorrhage or hematoma rate2022-07-01 to 2024-06-30 · 260 cases | 2.21 | 2.29 | 2.417 | No Different Than the National Rate | Better than 65% of US hospitals |
| Postoperative acute kidney injury requiring dialysis rate2022-07-01 to 2024-06-30 · 61 cases | 1.66 | 1.63 | 1.579 | No Different Than the National Rate | Worse than 64% of US hospitals |
| Postoperative respiratory failure rate2022-07-01 to 2024-06-30 · 62 cases | 8.66 | 8.88 | 8.895 | No Different Than the National Rate | Better than 56% of US hospitals |
| Perioperative pulmonary embolism or deep vein thrombosis rate2022-07-01 to 2024-06-30 · 267 cases | 3.11 | 3.4 | 3.842 | No Different Than the National Rate | Better than 75% of US hospitals |
| Postoperative sepsis rate2022-07-01 to 2024-06-30 · 51 cases | 5.98 | 5.105 | 5.092 | No Different Than the National Rate | Worse than 80% of US hospitals |
| Postoperative wound dehiscence rate2022-07-01 to 2024-06-30 · 69 cases | 1.72 | 1.72 | 1.765 | No Different Than the National Rate | Better than 48% of US hospitals |
| Abdominopelvic accidental puncture or laceration rate2022-07-01 to 2024-06-30 · 208 cases | 1.28 | 1.02 | 1.22 | No Different Than the National Rate | Worse than 87% of US hospitals |
Unplanned returns to a hospital after a stay or an outpatient procedure; lower is better.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Hospital return days for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 9.6 | |||
| Hospital return days for heart failure patients2022-07-01 to 2025-06-30 · 122 cases | 95 | 1.25 | 21.92 | Worse than 98% of US hospitals | |
| Hospital return days for pneumonia patients2022-07-01 to 2025-06-30 · 140 cases | -31.6 | 3.85 | 5.255 | Better than 90% of US hospitals | |
| Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)2024-07-01 to 2025-06-30 | Not Available | ||||
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)2022-01-01 to 2024-12-31 · 746 cases | 13.8 | 12.9 | 12.99 | No Different Than the National Rate | Worse than 85% of US hospitals |
| Rate of inpatient admissions for patients receiving outpatient chemotherapy2024-01-01 to 2024-12-31 · 67 cases | 10.1 | 10.7 | 10.2 | No Different Than the National Rate | Better than 68% of US hospitals |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy2024-01-01 to 2024-12-31 · 67 cases | 5.9 | 5.3 | 6.222 | No Different Than the National Rate | Worse than 78% of US hospitals |
| Ratio of unplanned hospital visits after hospital outpatient surgery2024-01-01 to 2024-12-31 · 241 cases | 1.1 | 1 | 1.118 | No Different than expected | Worse than 69% of US hospitals |
| Acute Myocardial Infarction (AMI) 30-Day Readmission Rate2023-07-01 to 2025-06-30 | Not Available | 14.19 | |||
| Rate of readmission for CABG2023-07-01 to 2025-06-30 | Not Available | 10.83 | |||
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patients2023-07-01 to 2025-06-30 · 36 cases | 19.6 | 19.8 | 19.52 | Better than 58% of US hospitals | |
| Heart failure (HF) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 167 cases | 21.2 | 21.3 | 21.05 | Better than 53% of US hospitals | |
| Rate of readmission after hip/knee replacement2023-07-01 to 2025-06-30 | Not Available | 5.68 | |||
| Pneumonia (PN) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 212 cases | 16.2 | 17.2 | 16.64 | Better than 88% of US hospitals |
Standardized infection ratios (1 is the US baseline) and the counts behind them; lower is better.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Central Line Associated Bloodstream Infection (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | 0.043 | 0.172 | 0.2329 | No Different than National Benchmark | |
| Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | 4.205 | 1.504 | 2.335 | No Different than National Benchmark | |
| Central Line Associated Bloodstream Infection: Number of Device Days2024-10-01 to 2025-09-30 | 1,953 | 1,370 | 5,053 | No Different than National Benchmark | |
| Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 1.173 | 0.9835 | 4.482 | No Different than National Benchmark | |
| Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 1 | 0 | 2.5 | No Different than National Benchmark | |
| Central Line Associated Bloodstream Infection (ICU + select Wards)2024-10-01 to 2025-09-30 | 0.853 | 0.484 | 0.7274 | No Different than National Benchmark | Worse than 77% of US hospitals |
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2057 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.329 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days2024-10-01 to 2025-09-30 | 1,829 | 1,799 | 4,489 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.933 | 1.377 | 4.821 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 2 | 0 | 3.429 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards)2024-10-01 to 2025-09-30 | Not Available | 0.7816 | |||
| SSI - Colon Surgery: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.3714 | |||
| SSI - Colon Surgery: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.964 | |||
| SSI - Colon Surgery: Number of Procedures2024-10-01 to 2025-09-30 | 21 | 61 | 84.83 | ||
| SSI - Colon Surgery: Predicted Cases2024-10-01 to 2025-09-30 | 0.507 | 1.591 | 2.192 | ||
| SSI - Colon Surgery: Observed Cases2024-10-01 to 2025-09-30 | 0 | 1 | 2.333 | ||
| SSI - Colon Surgery2024-10-01 to 2025-09-30 | Not Available | 1.054 | |||
| SSI - Abdominal Hysterectomy: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | ||||
| SSI - Abdominal Hysterectomy: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | ||||
| SSI - Abdominal Hysterectomy: Number of Procedures2024-10-01 to 2025-09-30 | 26 | 38 | 30.17 | ||
| SSI - Abdominal Hysterectomy: Predicted Cases2024-10-01 to 2025-09-30 | 0.215 | 0.328 | 0.2526 | ||
| SSI - Abdominal Hysterectomy: Observed Cases2024-10-01 to 2025-09-30 | 1 | 0 | 0.3333 | ||
| SSI - Abdominal Hysterectomy2024-10-01 to 2025-09-30 | Not Available | ||||
| MRSA Bacteremia: Lower Confidence Limit2024-10-01 to 2025-09-30 | 0.046 | 0.193 | 0.0446 | No Different than National Benchmark | |
| MRSA Bacteremia: Upper Confidence Limit2024-10-01 to 2025-09-30 | 4.496 | 1.855 | 2.003 | No Different than National Benchmark | |
| MRSA Bacteremia: Patient Days2024-10-01 to 2025-09-30 | 17,510 | 14,451 | 43,478 | No Different than National Benchmark | |
| MRSA Bacteremia: Predicted Cases2024-10-01 to 2025-09-30 | 1.097 | 0.567 | 2.397 | No Different than National Benchmark | |
| MRSA Bacteremia: Observed Cases2024-10-01 to 2025-09-30 | 1 | 0 | 0.6429 | No Different than National Benchmark | |
| MRSA Bacteremia2024-10-01 to 2025-09-30 | 0.912 | 0.597 | 0.2263 | No Different than National Benchmark | Worse than 74% of US hospitals |
| Clostridium Difficile (C.Diff): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2111 | Better than the National Benchmark | ||
| Clostridium Difficile (C.Diff): Upper Confidence Limit2024-10-01 to 2025-09-30 | 0.585 | 0.747 | 1.026 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff): Patient Days2024-10-01 to 2025-09-30 | 16,782 | 13,646 | 44,003 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff): Predicted Cases2024-10-01 to 2025-09-30 | 5.125 | 5.683 | 21.87 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff): Observed Cases2024-10-01 to 2025-09-30 | 0 | 2 | 8.429 | Better than the National Benchmark | |
| Clostridium Difficile (C.Diff)2024-10-01 to 2025-09-30 | 0 | 0.279 | 0.4274 | Better than the National Benchmark | The best result, shared by 19% of US hospitals |
How recent inpatients answered each survey question, with CMS's star rating per topic.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Room was "always" clean2024-10-01 to 2025-09-30 · 427 cases | 76 | 73 | 76.47 | Better than 60% of US hospitals | |
| Room was "sometimes" or "never" clean2024-10-01 to 2025-09-30 · 427 cases | 7 | 8 | 6.733 | Better than 56% of US hospitals | |
| Room was "usually" clean2024-10-01 to 2025-09-30 · 427 cases | 17 | 18 | 16.8 | ||
| Cleanliness - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 89 | 87 | 88.46 | Better than 66% of US hospitals | |
| Cleanliness - star rating2024-10-01 to 2025-09-30 · 427 cases | 4 | 4 | 3.923 | Better than 47% of US hospitals | |
| Nurses "always" communicated well2024-10-01 to 2025-09-30 · 427 cases | 79 | 80 | 79.2 | Worse than 51% of US hospitals | |
| Nurse communication - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 92 | 91 | 91.85 | Better than 51% of US hospitals | |
| Nurses "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 427 cases | 4 | 4 | 4.2 | Worse than 42% of US hospitals | |
| Nurse communication - star rating2024-10-01 to 2025-09-30 · 427 cases | 4 | 3 | 3.769 | Better than 51% of US hospitals | |
| Nurses "usually" communicated well2024-10-01 to 2025-09-30 · 427 cases | 17 | 16 | 16.6 | ||
| Doctors "always" communicated well2024-10-01 to 2025-09-30 · 427 cases | 81 | 79 | 79.73 | Better than 59% of US hospitals | |
| Doctor communication - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 92 | 91 | 91.62 | Better than 63% of US hospitals | |
| Doctors "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 427 cases | 6 | 5 | 5.267 | Worse than 56% of US hospitals | |
| Doctor communication - star rating2024-10-01 to 2025-09-30 · 427 cases | 4 | 3 | 3.462 | Better than 63% of US hospitals | |
| Doctors "usually" communicated well2024-10-01 to 2025-09-30 · 427 cases | 13 | 16 | 15 | ||
| Staff "always" explained2024-10-01 to 2025-09-30 · 427 cases | 63 | 61 | 61.8 | Better than 58% of US hospitals | |
| Communication about medicines - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 79 | 77 | 78.62 | Better than 65% of US hospitals | |
| Staff "sometimes" or "never" explained2024-10-01 to 2025-09-30 · 427 cases | 17 | 19 | 17.13 | Better than 63% of US hospitals | |
| Communication about medicines - star rating2024-10-01 to 2025-09-30 · 427 cases | 3 | 3 | 3 | Better than 47% of US hospitals | |
| Staff "usually" explained2024-10-01 to 2025-09-30 · 427 cases | 20 | 19 | 21.07 | ||
| Discharge information - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 86 | 86 | 86.46 | Worse than 45% of US hospitals | |
| No, staff "did not" give patients this information2024-10-01 to 2025-09-30 · 427 cases | 14 | 13 | 13.27 | Worse than 53% of US hospitals | |
| Discharge information - star rating2024-10-01 to 2025-09-30 · 427 cases | 3 | 3 | 3.462 | Worse than 45% of US hospitals | |
| Yes, staff "did" give patients this information2024-10-01 to 2025-09-30 · 427 cases | 86 | 87 | 86.73 | Worse than 53% of US hospitals | |
| No, staff "did not" give patients information about help after discharge2024-10-01 to 2025-09-30 · 427 cases | 14 | 14 | 14.85 | Better than 49% of US hospitals | |
| Yes, staff "did" give patients information about help after discharge2024-10-01 to 2025-09-30 · 427 cases | 86 | 86 | 85.15 | Better than 49% of US hospitals | |
| Doctors "always" explained things so they could understand2024-10-01 to 2025-09-30 · 427 cases | 76 | 74 | 75.38 | Better than 61% of US hospitals | |
| Doctors "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 427 cases | 8 | 7 | 6.538 | Worse than 63% of US hospitals | |
| Doctors "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 427 cases | 16 | 19 | 18.08 | ||
| Doctors "always" listened carefully2024-10-01 to 2025-09-30 · 427 cases | 81 | 77 | 78.92 | Better than 71% of US hospitals | |
| Doctors "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 427 cases | 5 | 6 | 5.154 | Better than 53% of US hospitals | |
| Doctors "usually" listened carefully2024-10-01 to 2025-09-30 · 427 cases | 14 | 17 | 15.92 | ||
| Doctors "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 427 cases | 87 | 85 | 85.31 | Better than 62% of US hospitals | |
| Doctors "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 427 cases | 4 | 3 | 3.385 | Worse than 51% of US hospitals | |
| Doctors "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 427 cases | 9 | 11 | 11.31 | ||
| Patients who gave a rating of "6" or lower (low)2024-10-01 to 2025-09-30 · 427 cases | 8 | 8 | 8 | Worse than 48% of US hospitals | |
| Patients who gave a rating of "7" or "8" (medium)2024-10-01 to 2025-09-30 · 427 cases | 21 | 20 | 21.2 | ||
| Patients who gave a rating of "9" or "10" (high)2024-10-01 to 2025-09-30 · 427 cases | 71 | 72 | 70.8 | Worse than 51% of US hospitals | |
| Overall hospital rating - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 89 | 88 | 88.38 | Better than 55% of US hospitals | |
| Overall hospital rating - star rating2024-10-01 to 2025-09-30 · 427 cases | 4 | 3 | 3.308 | Better than 55% of US hospitals | |
| Staff "always" explained new medications2024-10-01 to 2025-09-30 · 427 cases | 76 | 74 | 74.46 | Better than 59% of US hospitals | |
| Staff "sometimes" or "never" explained new medications2024-10-01 to 2025-09-30 · 427 cases | 8 | 9 | 8.615 | Better than 60% of US hospitals | |
| Staff "usually" explained new medications2024-10-01 to 2025-09-30 · 427 cases | 16 | 16 | 16.92 | ||
| Nurses "always" explained things so they could understand2024-10-01 to 2025-09-30 · 427 cases | 75 | 75 | 75.46 | Better than 48% of US hospitals | |
| Nurses "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 427 cases | 6 | 5 | 5.538 | Worse than 51% of US hospitals | |
| Nurses "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 427 cases | 19 | 20 | 19 | ||
| Nurses "always" listened carefully2024-10-01 to 2025-09-30 · 427 cases | 77 | 77 | 76.62 | Better than 49% of US hospitals | |
| Nurses "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 427 cases | 5 | 4 | 4.077 | Worse than 55% of US hospitals | |
| Nurses "usually" listened carefully2024-10-01 to 2025-09-30 · 427 cases | 18 | 19 | 19.31 | ||
| Nurses "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 427 cases | 86 | 86 | 86 | Worse than 47% of US hospitals | |
| Nurses "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 427 cases | 2 | 3 | 2.385 | Better than 50% of US hospitals | |
| Nurses "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 427 cases | 12 | 11 | 11.62 | ||
| "Always" quiet at night2024-10-01 to 2025-09-30 · 427 cases | 58 | 59 | 53.73 | Worse than 53% of US hospitals | |
| "Sometimes" or "never" quiet at night2024-10-01 to 2025-09-30 · 427 cases | 9 | 9 | 12.33 | Worse than 47% of US hospitals | |
| "Usually" quiet at night2024-10-01 to 2025-09-30 · 427 cases | 33 | 31 | 33.93 | ||
| Quietness - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 82 | 82 | 78.54 | Better than 48% of US hospitals | |
| Quietness - star rating2024-10-01 to 2025-09-30 · 427 cases | 3 | 3 | 2.769 | Worse than 44% of US hospitals | |
| "NO", patients would not recommend the hospital (they probably would not or definitely would not recommend it)2024-10-01 to 2025-09-30 · 427 cases | 4 | 5 | 5 | Better than 57% of US hospitals | |
| "YES", patients would definitely recommend the hospital2024-10-01 to 2025-09-30 · 427 cases | 70 | 71 | 71.93 | Worse than 53% of US hospitals | |
| Recommend hospital - linear mean score2024-10-01 to 2025-09-30 · 427 cases | 88 | 87 | 88.31 | Better than 51% of US hospitals | |
| "YES", patients would probably recommend the hospital2024-10-01 to 2025-09-30 · 427 cases | 26 | 23 | 23.07 | ||
| Recommend hospital - star rating2024-10-01 to 2025-09-30 · 427 cases | 4 | 4 | 3.923 | Better than 42% of US hospitals | |
| Staff "always" explained possible side effects2024-10-01 to 2025-09-30 · 427 cases | 51 | 47 | 49.69 | Better than 67% of US hospitals | |
| Staff "sometimes" or "never" explained possible side effects2024-10-01 to 2025-09-30 · 427 cases | 27 | 30 | 27.62 | Better than 65% of US hospitals | |
| Staff "usually" explained possible side effects2024-10-01 to 2025-09-30 · 427 cases | 22 | 22 | 22.69 | ||
| Summary star rating2024-10-01 to 2025-09-30 · 427 cases | 4 | 3 | 3.462 | Better than 60% of US hospitals | |
| No, staff "did not" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 427 cases | 14 | 12 | 11.92 | Worse than 63% of US hospitals | |
| Yes, staff "did" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 427 cases | 86 | 88 | 88.08 | Worse than 63% of US hospitals |
How often the hospital gave recommended care, and how fast.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Emergency department volume2024-01-01 to 2024-12-31 | medium | ||||
| Global Malnutrition Composite Score2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Malnutrition Diagnosis Documented2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Malnutrition Risk Screening2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Nutrition Assessment2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Nutritional Care Plan2024-01-01 to 2024-12-31 | Not Available | ||||
| Hospital Harm - Severe Hyperglycemia2024-01-01 to 2024-12-31 | Not Available | 4.6 | |||
| Hospital Harm - Severe Hypoglycemia2024-01-01 to 2024-12-31 | Not Available | 0.25 | |||
| Hospital Harm - Opioid Related Adverse Events2024-01-01 to 2024-12-31 | Not Available | 0 | |||
| Healthcare workers given influenza vaccination2024-10-01 to 2025-03-31 · 1,030 cases | 65 | 79 | 65.63 | Worse than 71% of US hospitals | |
| Average (median) time all patients spent in the emergency department before leaving from the visit, including psychiatric/mental health patients and patients who were transferred to another facility. A lower number of minutes is better2024-10-01 to 2025-09-30 · 383 cases | 159 | 154 | 119 | Worse than 53% of US hospitals | |
| Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better2024-10-01 to 2025-09-30 · 363 cases | 156 | 148 | 120 | Worse than 55% of US hospitals | |
| Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better2024-10-01 to 2025-09-30 · 15 cases | 254 | 247 | 196 | Worse than 53% of US hospitals | |
| Average (median) time patients spent in the emergency department before being transferred to another facility. A lower number of minutes is better2024-10-01 to 2025-09-30 | Not Available | 277 | |||
| Left before being seen2024-01-01 to 2024-12-31 · 23,929 cases | 2 | 1 | 0.8824 | Worse than 58% of US hospitals | |
| Head CT results2024-10-01 to 2025-09-30 · 20 cases | 80 | 74 | 68.14 | Better than 62% of US hospitals | |
| Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients2024-01-01 to 2024-12-31 · 391 cases | 99 | 97 | 91.73 | Better than 63% of US hospitals | |
| Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery2024-01-01 to 2024-12-31 | Not Available | ||||
| ST-Segment Elevation Myocardial Infarction (STEMI)2024-01-01 to 2024-12-31 | Not Available | ||||
| Safe Use of Opioids - Concurrent Prescribing2024-01-01 to 2024-12-31 · 547 cases | 15 | 15 | 11.31 | Worse than 48% of US hospitals | |
| Appropriate care for severe sepsis and septic shock2024-10-01 to 2025-09-30 · 182 cases | 81 | 65 | 76.08 | Better than 86% of US hospitals | |
| Septic Shock 3-Hour Bundle2024-10-01 to 2025-09-30 · 87 cases | 84 | 73 | 85 | Better than 74% of US hospitals | |
| Septic Shock 6-Hour Bundle2024-10-01 to 2025-09-30 · 60 cases | 97 | 88 | 87.36 | Better than 82% of US hospitals | |
| Severe Sepsis 3-Hour Bundle2024-10-01 to 2025-09-30 · 182 cases | 94 | 82 | 90.67 | Better than 93% of US hospitals | |
| Severe Sepsis 6-Hour Bundle2024-10-01 to 2025-09-30 · 143 cases | 95 | 94 | 92.92 | Better than 51% of US hospitals | |
| Discharged on Antithrombotic Therapy2024-01-01 to 2024-12-31 · 74 cases | 97 | 98 | 95.7 | Worse than 51% of US hospitals | |
| Anticoagulation Therapy for Atrial Fibrillation/Flutter2024-01-01 to 2024-12-31 | Not Available | 71.75 | |||
| Antithrombotic Therapy by End of Hospital Day 22024-01-01 to 2024-12-31 · 61 cases | 97 | 94 | 92.86 | Better than 73% of US hospitals | |
| Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 | Not Available | 70.5 | |||
| Intensive Care Unit Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 | Not Available | 88.33 |
How often scans were ordered when they may not be needed; lower is better.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Abdomen CT Use of Contrast Material2024-07-01 to 2025-06-30 | 5.3 | 5 | 4.446 | Worse than 53% of US hospitals | |
| Breast Cancer Screening Recall Rates2024-07-01 to 2025-06-30 | 3.2 | 6.6 | 6.189 | Better than 91% of US hospitals |
Medicare spending around an inpatient stay compared with the US (1 is the US median).
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Medicare hospital spending per patient (Medicare Spending per Beneficiary)2024-01-01 to 2024-12-31 | 0.82 | 0.99 | 0.8855 | Better than 97% of US hospitals |
The scores Medicare uses to raise or lower inpatient payments; higher is better.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| VBP clinical outcomes domain scoreFY 2026 | 0 | 20 | 20.86 | The worst result, shared by 11% of US hospitals | |
| VBP clinical outcomes weighted domain scoreFY 2026 | 0 | 5 | 5.216 | The worst result, shared by 11% of US hospitals | |
| VBP efficiency and cost reduction domain scoreFY 2026 | 90 | 10 | 61.82 | Better than 96% of US hospitals | |
| VBP efficiency and cost reduction weighted domain scoreFY 2026 | 22.5 | 2.5 | 15.45 | Better than 95% of US hospitals | |
| VBP person and community engagement domain scoreFY 2026 | 32 | 34 | 38.64 | Worse than 54% of US hospitals | |
| VBP person and community engagement weighted domain scoreFY 2026 | 8 | 8.75 | 9.659 | Worse than 54% of US hospitals | |
| VBP safety domain scoreFY 2026 | 40 | 40 | 42.33 | Worse than 49% of US hospitals | |
| VBP safety weighted domain scoreFY 2026 | 10 | 10 | 10.58 | Worse than 49% of US hospitals | |
| VBP total performance scoreFY 2026 | 40.5 | 29.5 | 40.91 | Better than 81% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| VBP clinical outcomes domain score | 34 | 50 | 40 | 0 | 0 | 0 |
| VBP clinical outcomes weighted domain score | 8.5 | 12.5 | 10 | 0 | 0 | 0 |
| VBP efficiency and cost reduction domain score | 60 | Not Available | 50 | 70 | 90 | 90 |
| VBP efficiency and cost reduction weighted domain score | 15 | Not Available | 12.5 | 17.5 | 22.5 | 22.5 |
| VBP person and community engagement domain score | 38 | Not Available | Not Available | 17 | 27 | 32 |
| VBP person and community engagement weighted domain score | 9.5 | Not Available | Not Available | 4.25 | 6.75 | 8 |
| VBP safety domain score | 46.67 | Not Available | Not Available | 10 | 46.67 | 40 |
| VBP safety weighted domain score | 11.67 | Not Available | Not Available | 2.5 | 11.67 | 10 |
| VBP total performance score | 44.67 | Not Available | Not Available | 24.25 | 40.92 | 40.5 |
Excess readmission ratios by condition; above 1 means more readmissions than expected.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| READM-30-AMI-HRRP2021-07-01 to 2024-06-30 | N/A | 1.005 | |||
| READM-30-CABG-HRRP2021-07-01 to 2024-06-30 | N/A | 0.9704 | |||
| READM-30-COPD-HRRP2021-07-01 to 2024-06-30 | N/A | 0.9963 | |||
| READM-30-HF-HRRP2021-07-01 to 2024-06-30 · 126 cases | 1.156 | 0.9983 | 1.003 | Worse than 99% of US hospitals | |
| READM-30-HIP-KNEE-HRRP2021-07-01 to 2024-06-30 | N/A | 0.9556 | |||
| READM-30-PN-HRRP2021-07-01 to 2024-06-30 | 0.9175 | 0.9955 | 0.9561 | Better than 92% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| READM-30-AMI-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-CABG-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-COPD-HRRP | 0.9797 | 0.9694 | N/A | N/A | N/A | N/A |
| READM-30-HF-HRRP | 1.046 | 1.049 | 1.025 | 1.01 | 1.054 | 1.156 |
| READM-30-HIP-KNEE-HRRP | 0.8698 | 0.8992 | 0.9181 | N/A | N/A | N/A |
| READM-30-PN-HRRP | 0.959 | 0.9895 | 0.9936 | 0.9854 | 0.9628 | 0.9175 |
Infection ratios, the PSI 90 composite and the total score Medicare ranks hospitals on; lower is better.
| Measure | Wilcox Health | US median | HI average | CMS comparison | US rank |
|---|---|---|---|---|---|
| CAUTI standardized infection ratio2023-01-01 to 2024-12-31 | 1.333 | 0.489 | 0.9801 | Worse than 93% of US hospitals | |
| CDI standardized infection ratio2023-01-01 to 2024-12-31 | 0 | 0.346 | 0.5455 | The best result, shared by 9% of US hospitals | |
| CLABSI standardized infection ratio2023-01-01 to 2024-12-31 | 1.11 | 0.559 | 0.8835 | Worse than 87% of US hospitals | |
| HAC Reduction Program payment reductionFY 2026 | Yes | ||||
| MRSA standardized infection ratio2023-01-01 to 2024-12-31 | 0 | 0.6405 | 0.4982 | The best result, shared by 12% of US hospitals | |
| Patient safety and adverse events composite (PSI 90)2022-07-01 to 2024-06-30 | 1.042 | 0.9628 | 1.068 | Worse than 72% of US hospitals | |
| SSI standardized infection ratio2023-01-01 to 2024-12-31 | 2.865 | 0.7945 | 1.393 | Worse than 99% of US hospitals | |
| Total HAC scoreFY 2026 | 0.4478 | -0.0453 | 0.4309 | Worse than 78% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| HAC Reduction Program payment reduction | No | No | N/A | Yes | Yes | Yes |
| Total HAC score | 0.2074 | 0.0993 | 0 | 0.8543 | 0.604 | 0.4478 |
Source: CMS Care Compare hospital files, latest release 2026-09-30, with program results for earlier fiscal years from CMS's archived snapshots. US medians and ranks count every hospital CMS reports; state averages are plain means of the state's reporting hospitals, not CMS's patient-weighted state rates.
The Joint Commission (since 2004)
Accreditation
None
Medical school affiliation
Federal
Ownership type
71
Medicare-certified beds
70
Registered nurses (full-time equivalent)
1966
In Medicare since
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What Wilcox Health reported to Medicare in its latest cost report, covering Jul 1, 2024 to Jun 30, 2025.
2,907
Inpatient discharges
Medicare 22%, Medicaid 0%
14,817
Inpatient days
56% of available bed days used
441
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 835976). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges Wilcox Health reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 3,343 | 5 | 11,469 | 14,817 |
| Discharges | 639 | 3 | 2,265 | 2,907 |
| Average length of stay | 5.2 days | 1.7 days | 5.1 days | 5.1 days |
| Average daily census | 9.2 | 0.0 | 31.4 | 40.6 |
4,022
Medicare Advantage days
635 discharges
3,530
Medicaid managed care days
829 discharges
2,524
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 65 | 12,639 | 3,058 | 53% |
| Intensive care unit | 7 | 1,412 | 285 | 55% |
| Nursery | 766 |
Source: CMS cost report (HCRIS, Form 2552-10), report 835976, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
What Wilcox Health treats Medicare patients for most often, in 2024. 201 Medicare discharges in 9 published DRGs; 7% surgical; 92% in DRGs with complications (CC or MCC).
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Septicemia or severe sepsis without MV >96 hours with MCCMS-DRG 871, medical | 46 | $54,739 | $22,751 | $18,940 | 1.98 |
| Heart failure and shock with MCCMS-DRG 291, medical | 32 | $30,713 | $12,931 | $10,627 | 1.28 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 27 | $40,573 | $14,978 | $14,038 | 1.33 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 24 | $50,361 | $19,821 | $17,425 | 1.70 |
| Cellulitis without MCCMS-DRG 603, medical | 17 | $29,269 | $9,673 | $10,127 | 0.88 |
| Intracranial hemorrhage or cerebral infarction with MCCMS-DRG 064, medical | 15 | $60,021 | $23,415 | $20,767 | 2.00 |
| Hip and femur procedures except major joint with CCMS-DRG 481, surgical | 15 | $64,507 | $22,581 | $22,319 | 2.07 |
| Gastrointestinal hemorrhage with CCMS-DRG 378, medical | 13 | $30,027 | $10,190 | $10,389 | 0.98 |
| Renal failure with MCCMS-DRG 682, medical | 12 | $33,867 | $16,921 | $11,718 | 1.50 |
Source: CMS Medicare Inpatient Hospitals by Provider and Service (2024 data, released 2026-04-10), traditional Medicare only; CMS omits DRGs with fewer than 11 discharges. Estimated cost is average charges times the hospital's Medicare cost-to-charge ratio from the IPPS Impact File. Weights are the MS-DRG relative weights for the same year.
The comprehensive outpatient service groups (APCs) Wilcox Health billed Medicare for most in 2024: 625 services in all.
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Comprehensive Observation ServicesAPC 8011 | 167 | 159 | $15,465 | $2,638 | $2,090 |
| Level 5 Musculoskeletal ProceduresAPC 5115 | 85 | 83 | $49,057 | $13,862 | $10,772 |
| Level 1 Intraocular ProceduresAPC 5491 | 76 | 60 | $10,168 | $2,286 | $1,752 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 64 | 61 | $7,777 | $1,526 | $1,196 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 55 | 54 | $27,256 | $6,786 | $5,339 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 46 | 45 | $6,011 | $1,468 | $1,220 |
| Level 3 Musculoskeletal ProceduresAPC 5113 | 29 | 28 | $12,690 | $3,089 | $2,373 |
| Level 1 Laparoscopy and Related ServicesAPC 5361 | 23 | 23 | $25,961 | $5,663 | $4,358 |
| Level 3 Excision/ Biopsy/ Incision and DrainageAPC 5073 | 22 | 20 | $13,468 | $2,541 | $2,141 |
| Level 6 Musculoskeletal ProceduresAPC 5116 | 18 | 18 | $73,371 | $20,082 | $15,763 |
See all 13 Medicare outpatient services at Wilcox Health
Source: CMS Medicare Outpatient Hospitals by Provider and Service (2024 data, released 2026-06-24), comprehensive APCs for traditional Medicare; CMS omits services with fewer than 11 claims. The US average weights every hospital by its services.
ZIP codes with the most Medicare inpatient stays at Wilcox Health in 2025. Market share is this hospital's part of every hospital's Medicare stays from the ZIP code. Its published Medicare stays went from 1,001 in 2020 to 1,095 in 2025.
| ZIP code | Stays | Of this hospital's stays | Days | Charges | Market share | Share in 2020 |
|---|---|---|---|---|---|---|
| 96766 | 339 | 31% | 2,266 | $17.9M | 76% | 77% |
| 96746 | 289 | 26% | 1,829 | $15.5M | 69% | 77% |
| 96756 | 107 | 10% | 726 | $6.4M | 69% | 86% |
| 96741 | 74 | 7% | 440 | $3.8M | 60% | 86% |
| 96754 | 53 | 5% | 226 | $2.5M | 68% | 100% |
| 96703 | 50 | 5% | 426 | $2.9M | 100% | 73% |
| 96765 | 32 | 3% | 96 | $1.2M | 100% | 100% |
| 96722 | 28 | 3% | 218 | $1.8M | 100% | 100% |
| 96752 | 28 | 3% | 206 | $1.7M | 31% | 34% |
| 96714 | 27 | 2% | 154 | $1.4M | 68% | 100% |
| 96705 | 25 | 2% | 130 | $1.1M | 57% | 48% |
| 96716 | 18 | 2% | 145 | $1M | 39% | 41% |
| 96796 | 13 | 1% | 83 | $695,925 | 24% | 31% |
| 96715 | 12 | 1% | 76 | $683,267 | 100% |
Source: CMS Hospital Service Area file. Shares are of the 1,095 stays from ZIP codes CMS publishes; it omits ZIP codes with fewer than 11 stays, so market shares count published stays only.
Staff by profession and the rooms and units Wilcox Health reported at its latest Medicare certification survey (2005). Counts are people, not full-time equivalents.
1
Off-site locations
70
Registered nurses
12
Licensed practical nurses
1
Nurse anesthetists (CRNAs)
3
Pharmacists
9
Respiratory therapists
7
Physical therapists
3
Occupational therapists
1
Speech pathologists and audiologists
12
Radiology technicians
2
Nuclear medicine technicians
2
Dietitians
2
Social workers
Source: CMS Provider of Services file.
278 clinicians who bill Medicare list Wilcox Health as a hospital affiliation. Showing 24 of them. Book a demo to see the commercial rates insurers publish for them, or start a free trial.
Ken Arakawa, M.D.
Specialist
NPI 1558334888
See commercial rates for Ken Arakawa, M.D.Surendra Rao, M.D.
Neurology Physician
NPI 1871698688
See commercial rates for Surendra Rao, M.D.Sian Yik Lim, MD
Rheumatology Physician
NPI 1992092225
See commercial rates for Sian Yik Lim, MDArnold Kop, M.D.
Internal Medicine Physician
NPI 1629178157
See commercial rates for Arnold Kop, M.D.Sheri Chinen, M.D.
Endocrinology, Diabetes & Metabolism Physician
NPI 1487873600
See commercial rates for Sheri Chinen, M.D.James Sheperd, MD
Diagnostic Radiology Physician
NPI 1407818263
See commercial rates for James Sheperd, MDOwen Chan, MD, PHD
Anatomic Pathology & Clinical Pathology Physician
NPI 1629309620
See commercial rates for Owen Chan, MD, PHDMicheal Johnson, D.O.
Diagnostic Radiology Physician
NPI 1205820842
See commercial rates for Micheal Johnson, D.O.Daniel Choi, MD
Pain Medicine (Anesthesiology) Physician
NPI 1164413696
See commercial rates for Daniel Choi, MDKamonkiat Wirunsawanya, M.D.
Endocrinology, Diabetes & Metabolism Physician
NPI 1639552599
See commercial rates for Kamonkiat Wirunsawanya, M.D.Young Kim, M.D.
Neuroradiology Physician
NPI 1144218108
See commercial rates for Young Kim, M.D.John Funai, M.D.
Cardiovascular Disease Physician
NPI 1710082912
See commercial rates for John Funai, M.D.Vineet Chib, M.D.
Diagnostic Radiology Physician
NPI 1750522603
See commercial rates for Vineet Chib, M.D.Nicholas Walle
Diagnostic Radiology Physician
NPI 1770701872
See commercial rates for Nicholas WalleAndrew So, D.O
Cardiovascular Disease Physician
NPI 1063679330
See commercial rates for Andrew So, D.OJeremy Lum, MD
Cardiovascular Disease Physician
NPI 1578602561
See commercial rates for Jeremy Lum, MDLucky Robinson, APRN, AGPC-NP-C
Adult Health Nurse Practitioner
NPI 1043873698
See commercial rates for Lucky Robinson, APRN, AGPC-NP-CJeffrey Chung, M.D.
Cardiovascular Disease Physician
NPI 1285749960
See commercial rates for Jeffrey Chung, M.D.Adam Protain, MD
Nephrology Physician
NPI 1083879803
See commercial rates for Adam Protain, MDAlexander Richardson, M.D.
Diagnostic Radiology Physician
NPI 1487997490
See commercial rates for Alexander Richardson, M.D.Albert Yeung
Diagnostic Radiology Physician
NPI 1679717326
See commercial rates for Albert YeungYang-En Kao, MD
Diagnostic Radiology Physician
NPI 1326013319
See commercial rates for Yang-En Kao, MDNisha Rao, MD
Diagnostic Radiology Physician
NPI 1063607216
See commercial rates for Nisha Rao, MDDaniel Judd, MD
Orthopaedic Surgery Physician
NPI 1073670360
See commercial rates for Daniel Judd, MDSource: CMS Doctors and Clinicians facility affiliations, released 2026-10-15, with names and specialties from NPPES. Affiliation means the clinician bills Medicare for care at this hospital; it is not employment.
Revenue, expenses and income Wilcox Health reported to Medicare for Jul 1, 2024 to Jun 30, 2025. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $433.8M | 277.5% |
| Inpatient | $132M | 84.4% |
| Outpatient | $301.9M | 193.1% |
| Contractual allowances and discounts | -$277.5M | -177.5% |
| Net patient revenue | $156.3M | 100.0% |
| Operating expenses | -$170.6M | -109.1% |
| Operating income from patient care | -$14.3M | -9.1% |
| Other income | $30.1M | 19.2% |
| Contributions and donations | $2.3M | 1.5% |
| Investment income | $649,004 | 0.4% |
| Other | $27.2M | 17.4% |
| Other expenses | -$118,126 | -0.1% |
| Net income | $15.7M | 10.0% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $75.1M | 17.3% |
| Medicaid (including managed care) | $68.6M | 15.8% |
| Other payers and self-pay | $290.1M | 66.9% |
| Total charges | $433.8M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 835976, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Traditional Medicare is the program charges on Worksheets D-3 and D Part V; Medicaid is from Worksheet S-10.
Computed from Wilcox Health's latest cost report.
-9.1%
Operating margin
Operating income from patient care / net patient revenue
8.4%
Total margin
Net income / net patient revenue plus other income
12.3%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
36% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$48.54
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
12.1%
Return on assets
Net income for a year / total assets
13.9%
Return on equity
Net income for a year / fund balance
2.03
Current ratio
Current assets / current liabilities
1.26
Quick ratio
Cash, temporary investments and net receivables / current liabilities
0 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
46 days
Days in patient receivables
Net patient receivables / daily net patient revenue
35 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
1.44
Asset turnover
Total revenue for a year / total assets
15.6 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 835976, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
What Wilcox Health owned and owed at the end of its reporting period (Jun 2025), across all fund types: $129.3M in total assets and a $113M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | -$37,642 | -0.0% |
| Patient receivables, net | $19.8M | 15.3% |
| Inventory | $5.4M | 4.2% |
| Total current assets | $31.8M | 24.6% |
| Property and equipment, net of depreciation | $59.8M | 46.3% |
| Investments and other assets | $37.7M | 29.2% |
| Total assets | $129.3M | 100.0% |
| Current liabilities | $15.7M | 12.1% |
| Total liabilities | $16.3M | 12.6% |
| Fund balance (net assets) | $113M | 87.4% |
Source: CMS cost report (HCRIS, Form 2552-10), report 835976, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Care Wilcox Health provided without full payment, as reported on Worksheet S-10 of its cost report.
$1.1M
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$2.9M
Bad debt
Patient bills written off as uncollectible, at charges
-$5.6M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$2M
Total unreimbursed and uncompensated care
1.1% of operating expenses
Medicaid, CHIP and indigent care shortfalls plus charity care and the cost of bad debt (Worksheet S-10 line 31)
Source: CMS cost report (HCRIS, Form 2552-10), report 835976, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Wilcox Health's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Jun 2020 | Jun 2021 | Jun 2022 | Jun 2023 | Jun 2024 | Jun 2025 |
|---|---|---|---|---|---|---|
| Net patient revenue | $124.6M | $125.4M | $142.9M | $152M | $153.7M | $156.3M |
| Operating expenses | $132.3M | $138.6M | $148.2M | $148M | $154.9M | $170.6M |
| Operating margin | -6.2% | -10.5% | -3.7% | 2.6% | -0.8% | -9.1% |
| Net income | $7.3M | $395,690 | $15.5M | $12.4M | $15.4M | $15.7M |
| Total assets | $96.4M | $106.5M | $110.9M | $110.4M | $121.6M | $129.3M |
| Discharges | 2,941 | 2,599 | 2,875 | 3,281 | 3,238 | 2,907 |
| Inpatient days | 15,958 | 13,371 | 14,832 | 17,047 | 17,034 | 14,817 |
| Medicare Advantage days | 3,254 | 2,769 | 3,225 | 4,005 | 4,706 | 4,022 |
| Beds | 72 | 72 | 72 | 72 | 72 | 72 |
| Employees (FTE) | 485 | 469 | 447 | 446 | 443 | 441 |
Source: CMS cost report (HCRIS, Form 2552-10), report 835976, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center Wilcox Health reports, largest first. Total cost includes its share of overhead; the cost-to-charge ratio is total cost / charges.
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Drugs charged to patients | $21.8M | $78.1M | 0.28 | ||
| Operating room | $6.6M | $17.5M | $60.9M | 0.29 | 239 |
| Emergency | $3.8M | $10.7M | $79.4M | 0.14 | |
| Impl. dev. charged to patients | $6.9M | $13.2M | 0.52 | ||
| Medical supplies charged to patient | $5.7M | $9.7M | 0.58 | ||
| Radiology-diagnostic | $1.7M | $4.7M | $13.4M | 0.35 | |
| Observation beds (non-distinct part | $3.9M | $10.2M | 0.38 | ||
| Laboratory | $308 | $3.6M | $15.9M | 0.23 | |
| Ct scan | $677,738 | $2.7M | $30.7M | 0.09 | |
| O/p treatment center | $1.2M | $2.6M | $5.7M | 0.46 | |
| Physical therapy | $1.4M | $2.5M | $6M | 0.41 | 75 |
| Respiratory therapy | $719,284 | $2.1M | $5.3M | 0.40 | 27 |
| Electrocardiology | $792,939 | $2M | $9.9M | 0.21 | |
| Delivery room & labor room | $1.9M | $3.3M | 0.58 | ||
| Ultra sound | $471,849 | $1.7M | $6M | 0.29 | |
| Clinic - womens center | $248,585 | $1.2M | $4M | 0.31 | |
| Mri | $461,534 | $1.2M | $10M | 0.12 | |
| Nuclear medicine - diagnostic | $172,531 | $1.1M | $1.8M | 0.60 | |
| Occupational therapy | $566,866 | $1.1M | $2.6M | 0.40 | |
| Anesthesiology | $122,835 | $588,450 | $12.2M | 0.05 | |
| Hemodialysis | $481,536 | $349,216 | 1.38 | 169 | |
| Speech pathology | $193,220 | $344,661 | $560,450 | 0.61 | |
| Cardiac rehabilitation | $114 | $623 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Adults & pediatrics | $10M | $23.2M | $41.7M | 0.55 | 25,187 |
| Intensive care unit | $2.3M | $5.2M | $11.2M | 0.47 | 2,861 |
| Nursery | $1.3M | $1.7M | 0.73 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Other administrative and general | $1.2M | $21.9M | 1,709 | ||
| Employee benefits department | $1,424 | $13.7M | |||
| Operation of plant | $1.5M | $5.2M | 44,792 | $33.63 | 156 |
| Cap rel costs-mvble equip | $3.2M | ||||
| Pharmacy | $2M | $3M | 36,067 | $54.98 | 2,661 |
| Nursing administration | $2.3M | $2.6M | 30,683 | $75.93 | 1,126 |
| Cap rel costs-bldg & fixt-new | $2.6M | ||||
| Housekeeping | $1.7M | $2.5M | 69,252 | $24.91 | 244 |
| Cashiering/accounts receivable | $114,817 | $2.1M | 231 | ||
| Medical records & library | $595,746 | $1.4M | 21,595 | $27.59 | |
| Social service | $1.1M | $1.2M | 15,196 | $72.51 | |
| Laundry & linen service | $999,931 | ||||
| Purchasing receiving and stores | $243,811 | $983,331 | |||
| Cap rel costs-bldg & fixt-old | $714,563 | ||||
| Cafeteria | $669,058 | 30,071 | $28.58 | 535 | |
| Cap rel costs-bldg & fixt | $630,264 | 46,119 | |||
| Dietary | $1.1M | $606,346 | 9,521 | $29.14 | 171 |
| Admitting | $521,346 | $549,181 | 447 | ||
| Central services & supply | $260,042 | $347,069 | 10,551 | $24.65 | |
| Cap rel costs-bldg & fixt-op | $335,883 | ||||
| Patient safety & quality | $133,831 | ||||
| Cap rel costs-bldg & fixt-lab & pt | $52,078 |
Source: CMS cost report (HCRIS, Form 2552-10), report 835976, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheets A, B-1, C Part I and S-3 Part II.
The factors Medicare uses to set what it pays Wilcox Health for an inpatient stay.
1.60
Case mix index
Higher than 40% of hospitals paid under Medicare IPPS
Average Medicare DRG weight of its inpatient cases (FY 2027); higher means more complex, costlier care.
No Medicare-funded residents
Teaching status
Medicare-funded interns and residents per bed (FY 2027).
28.3%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2027).
602
Medicare inpatient stays
Medicare claims CMS based FY 2027 payment rates on.
Rural
Location type
Geographic area CMS assigns before any wage index reclassification (FY 2027).
| IPPS fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 | FY 2027 |
|---|---|---|---|---|---|---|---|
| Case mix index | 1.56 | 1.56 | 1.58 | 1.59 | 1.51 | 1.63 | 1.60 |
| Wage index | 1.256 | 1.201 | 1.200 | 1.378 | 1.309 | 1.260 | 1.198 |
| Readmissions adjustment | -0.01% | -0.21% | -0.23% | -0.14% | -0.07% | -0.30% | -0.77% |
| Value-based purchasing adjustment | +0.51% | +0.87% | +0.87% | -1.12% | +0.30% | +1.66% | +0.79% |
| Medicare inpatient stays | 782 | 782 | 550 | 624 | 771 | 657 | 602 |
Source: CMS IPPS final rule Impact File (FY 2027).
Organizations Wilcox Health reports to Medicare as owners or with operational control.
Hawaii Pacific Health
5% or greater direct ownership interest, 100%, since 2001
Sources: CMS Hospital All Owners.
The officers and board members on Wilcox Health's Medicare enrollment and on the IRS Form 990 filed under its tax ID.
Source: CMS Hospital All Owners (PECOS), the people the hospital lists on its Medicare enrollment; the first 39 of 40 are shown.
340B drug pricing program
Participating since 2022
340B ID DSH120014, registered as a disproportionate share hospital; 17 active contract pharmacies. Authorizing official: Jen Chahanovich, CEO.
Source: HRSA 340B Office of Pharmacy Affairs Information System.
About Wilcox Health's rates and hospital price transparency.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Wilcox Health range from $181 to $2,787 across 4 insurers. UnitedHealthcare's rate is $181. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Colonoscopy with biopsy (CPT 45380), published negotiated rates at Wilcox Health range from $806 to $4,765 across 3 insurers. Aetna's rate is $3,883. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Vaginal delivery, hospital stay (MS-DRG 807), published negotiated rates at Wilcox Health range from $10,304 to $10,304 across 1 insurers. HMSA Blue Cross Blue Shield's rate is $10,304. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Wilcox Health range from $87 to $310 across 4 insurers. UnitedHealthcare's rate is $87. What a patient pays depends on their plan's deductible, coinsurance and network status.
Wilcox Health has a CMS overall hospital star rating of 2 out of 5 on Medicare Care Compare (CMS data released 2026-08-13). That is lower than 73% of US hospitals.
CMS reports no Medicare-funded interns or residents at Wilcox Health for fiscal year 2027.
Yes. Under the Hospital Readmissions Reduction Program, Medicare cuts Wilcox Health's base inpatient payments by an estimated 0.77% in fiscal year 2027 for more readmissions than expected.
In 2024, the most common were septicemia or severe sepsis without mv >96 hours with mcc (46 discharges), heart failure and shock with mcc (32 discharges), simple pneumonia and pleurisy with mcc (27 discharges).
Wilcox Health's Medicare case mix index is 1.60 for fiscal year 2027, higher than 40% of hospitals paid under the inpatient prospective payment system.
Wilcox Health reported 2,907 inpatient discharges and 14,817 inpatient days from Jul 1, 2024 to Jun 30, 2025.
Wilcox Health reported 441 full-time-equivalent employees on payroll from Jul 1, 2024 to Jun 30, 2025.
Wilcox Health reported $156.3M in net patient revenue on $433.8M of gross charges for Jul 1, 2024 to Jun 30, 2025, an operating margin of -9.1%, and net income of $15.7M.
Wilcox Health reported $2M of unreimbursed and uncompensated care for Jul 1, 2024 to Jun 30, 2025, including $1.1M of charity care at cost.
Wilcox Health's Medicare enrollment lists Dean Tateyama as Vice President Reimbursement since 2022.
Insurers' price transparency files list Wilcox Health under employer identification number 99-0074365 (Wilcox Memorial Hospital). 63 health plans and networks list 99-0074365 for it.
Yes. HRSA's 340B database lists Wilcox Health (340B ID DSH120014) as a participating disproportionate share hospital since 2022, with 17 active contract pharmacies.
278 clinicians who bill Medicare list Wilcox Health as a hospital affiliation in CMS's Doctors and Clinicians data. The largest groups are internal medicine physician (29), emergency medicine physician (28), family medicine physician (24).
Yes. CMS's Provider of Services file lists The Joint Commission as the accrediting organization for Wilcox Health, effective 2004.
In its Medicare enrollment, Wilcox Health reports Hawaii Pacific Health as 5% or greater direct ownership interest (100%).
CMS lists 34 services at Wilcox Health, including Acute Renal Dialysis, Anesthesia, Audiology, CARF Inpatient Rehabilitation (Commission On Accreditation Of Rehabilitation Facilities Inpatient Rehabilitation), Chemotherapy, Coronary Care Unit.
In CMS's 2025 Hospital Service Area file, the most Medicare inpatient stays at Wilcox Health came from ZIP codes 96766 (339), 96746 (289), 96756 (107).
Wilcox Health has 72 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. 71 are Medicare-certified beds in CMS's Provider of Services file. Facility type: Short Term Acute Care Hospital.
Wilcox Health is located at 3-3420 Kuhio Highway, Lihue, HI 96766. Its main phone number is (808) 245-1103.
Wilcox Health's CMS Certification Number (CCN), also called its Medicare provider number, is 120014.
The National Provider Identifier (NPI) on file for Wilcox Health is 1225113442.
Wilcox Health is affiliated with Hawaii Pacific Health.
Wilcox Health lists 35 in-network payers, including Aetna, Ameri Health, Aspirus Health Plan, Avera Health Plans, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
303 disclosed rate categories. Each shows the payer, category, code type and group with its code range, and contract type, along with how the rate compares with the state average.
Under 45 CFR Part 180, every US hospital must publish a machine-readable file of its standard charges, including gross charges, discounted cash prices and payer-specific negotiated rates, in the CMS template format. PayerPrice can help hospitals publish and maintain these files.
A chargemaster (charge description master, or CDM) is a hospital's master list of billable items, with codes, descriptions and gross charges. A chargemaster review looks at those lines for accuracy and pricing. PayerPrice can help hospitals review their chargemaster; contact us to discuss your needs.
For hospital finance and compliance teams
The data on this page comes from the files hospitals and payers publish. We help hospitals publish theirs correctly, and take a fresh look at their chargemaster.
We turn your chargemaster and payer contracts into the CMS template file, then keep it current as rates change.
{
"description": "MRI of brain (no contrast)",
"code_information": [
{ "code": "611", "type": "RC" },
{ "code": "70551", "type": "CPT" }
],
"standard_charges": [{
"setting": "outpatient",
"minimum": 250,
"maximum": 400,
"gross_charge": 1200,
"discounted_cash": 1080,
"payers_information": [
{
"payer_name": "Platform Health Insurance",
"plan_name": "PPO",
"methodology": "fee schedule",
"standard_charge_dollar": 400
},
{
"payer_name": "Region Health Insurance",
"plan_name": "HMO",
"methodology": "fee schedule",
"standard_charge_dollar": 250
}
]
}]
}Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.
What a review covers