Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NAIL FEMORA 11X380 04.013.556S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,985.00
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$3,017.20
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$3,334.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,017.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$3,017.20
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$3,017.20
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$3,017.20
Rate for Payer: Ohana Health Plan Medicare	$3,017.20
Rate for Payer: UnitedHealthcare Medicare	$3,017.20
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X380 04.013.556S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X400 04.013.560S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,985.00
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$3,017.20
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$3,334.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,017.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$3,017.20
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$3,017.20
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$3,017.20
Rate for Payer: Ohana Health Plan Medicare	$3,017.20
Rate for Payer: UnitedHealthcare Medicare	$3,017.20
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X400 04.013.560S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X420 04.013.564S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,985.00
Max. Negotiated Rate	$3,850.90
Rate for Payer: AlohaCare Medicaid	$1,985.00
Rate for Payer: AlohaCare Medicare	$3,017.20
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Devoted Health Medicare	$3,334.80
Rate for Payer: Hawaii Medical Service Association Medicare	$3,017.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Humana Medicare	$3,017.20
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: Kaiser Permanente Medicaid	$2,024.70
Rate for Payer: Kaiser Permanente Medicare	$3,017.20
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: Ohana Health Plan Medicaid	$3,017.20
Rate for Payer: Ohana Health Plan Medicare	$3,017.20
Rate for Payer: UnitedHealthcare Medicare	$3,017.20
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORA 11X420 04.013.564S

Facility

$3,970.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,223.20
Max. Negotiated Rate	$3,850.90
Rate for Payer: Cash Price	$2,382.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,779.00
Rate for Payer: Health Management Network Commercial	$3,374.50
Rate for Payer: Kaiser Permanente Commercial	$3,573.00
Rate for Payer: MDX Hawaii PPO	$3,850.90
Rate for Payer: University Health Alliance Commercial	$2,223.20

NAIL FEMORAL 12X300 2339-1230S

Facility

$6,838.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,829.28
Max. Negotiated Rate	$6,632.86
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: University Health Alliance Commercial	$3,829.28

NAIL FEMORAL 12X300 2339-1230S

Facility

$6,838.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,419.00
Max. Negotiated Rate	$6,632.86
Rate for Payer: AlohaCare Medicaid	$3,419.00
Rate for Payer: AlohaCare Medicare	$5,196.88
Rate for Payer: Cash Price	$4,102.80
Rate for Payer: Devoted Health Medicare	$5,743.92
Rate for Payer: Hawaii Medical Service Association Medicare	$5,196.88
Rate for Payer: Hawaii Western Management Group Commercial	$4,786.60
Rate for Payer: Health Management Network Commercial	$5,812.30
Rate for Payer: Humana Medicare	$5,196.88
Rate for Payer: Kaiser Permanente Commercial	$6,154.20
Rate for Payer: Kaiser Permanente Medicaid	$3,487.38
Rate for Payer: Kaiser Permanente Medicare	$5,196.88
Rate for Payer: MDX Hawaii PPO	$6,632.86
Rate for Payer: Ohana Health Plan Medicaid	$5,196.88
Rate for Payer: Ohana Health Plan Medicare	$5,196.88
Rate for Payer: UnitedHealthcare Medicare	$5,196.88
Rate for Payer: University Health Alliance Commercial	$3,829.28

NAIL FEMORAL 13X380 2339-1336S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Kaiser Permanente Commercial	$4,916.70
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL 13X380 2339-1336S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,731.50
Max. Negotiated Rate	$5,299.11
Rate for Payer: AlohaCare Medicaid	$2,731.50
Rate for Payer: AlohaCare Medicare	$4,151.88
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Devoted Health Medicare	$4,588.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4,151.88
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Humana Medicare	$4,151.88
Rate for Payer: Kaiser Permanente Commercial	$4,916.70
Rate for Payer: Kaiser Permanente Medicaid	$2,786.13
Rate for Payer: Kaiser Permanente Medicare	$4,151.88
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: Ohana Health Plan Medicaid	$4,151.88
Rate for Payer: Ohana Health Plan Medicare	$4,151.88
Rate for Payer: UnitedHealthcare Medicare	$4,151.88
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL GT LEFT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,433.50
Max. Negotiated Rate	$4,720.99
Rate for Payer: AlohaCare Medicaid	$2,433.50
Rate for Payer: AlohaCare Medicare	$3,698.92
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Devoted Health Medicare	$4,088.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,698.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Humana Medicare	$3,698.92
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: Kaiser Permanente Medicare	$3,698.92
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: Ohana Health Plan Medicaid	$3,698.92
Rate for Payer: Ohana Health Plan Medicare	$3,698.92
Rate for Payer: UnitedHealthcare Medicare	$3,698.92
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT LEFT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT LF

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT LF

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,433.50
Max. Negotiated Rate	$4,720.99
Rate for Payer: AlohaCare Medicaid	$2,433.50
Rate for Payer: AlohaCare Medicare	$3,698.92
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Devoted Health Medicare	$4,088.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,698.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Humana Medicare	$3,698.92
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: Kaiser Permanente Medicare	$3,698.92
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: Ohana Health Plan Medicaid	$3,698.92
Rate for Payer: Ohana Health Plan Medicare	$3,698.92
Rate for Payer: UnitedHealthcare Medicare	$3,698.92
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RIGHT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,433.50
Max. Negotiated Rate	$4,720.99
Rate for Payer: AlohaCare Medicaid	$2,433.50
Rate for Payer: AlohaCare Medicare	$3,698.92
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Devoted Health Medicare	$4,088.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,698.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Humana Medicare	$3,698.92
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: Kaiser Permanente Medicare	$3,698.92
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: Ohana Health Plan Medicaid	$3,698.92
Rate for Payer: Ohana Health Plan Medicare	$3,698.92
Rate for Payer: UnitedHealthcare Medicare	$3,698.92
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RIGHT

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RT 2333-0934S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,041.00
Max. Negotiated Rate	$5,899.54
Rate for Payer: AlohaCare Medicaid	$3,041.00
Rate for Payer: AlohaCare Medicare	$4,622.32
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Devoted Health Medicare	$5,108.88
Rate for Payer: Hawaii Medical Service Association Medicare	$4,622.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: Humana Medicare	$4,622.32
Rate for Payer: Kaiser Permanente Commercial	$5,473.80
Rate for Payer: Kaiser Permanente Medicaid	$3,101.82
Rate for Payer: Kaiser Permanente Medicare	$4,622.32
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: Ohana Health Plan Medicaid	$4,622.32
Rate for Payer: Ohana Health Plan Medicare	$4,622.32
Rate for Payer: UnitedHealthcare Medicare	$4,622.32
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-0934S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,405.92
Max. Negotiated Rate	$5,899.54
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: Kaiser Permanente Commercial	$5,473.80
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-0936S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,041.00
Max. Negotiated Rate	$5,899.54
Rate for Payer: AlohaCare Medicaid	$3,041.00
Rate for Payer: AlohaCare Medicare	$4,622.32
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Devoted Health Medicare	$5,108.88
Rate for Payer: Hawaii Medical Service Association Medicare	$4,622.32
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: Humana Medicare	$4,622.32
Rate for Payer: Kaiser Permanente Commercial	$5,473.80
Rate for Payer: Kaiser Permanente Medicaid	$3,101.82
Rate for Payer: Kaiser Permanente Medicare	$4,622.32
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: Ohana Health Plan Medicaid	$4,622.32
Rate for Payer: Ohana Health Plan Medicare	$4,622.32
Rate for Payer: UnitedHealthcare Medicare	$4,622.32
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-0936S

Facility

$6,082.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,405.92
Max. Negotiated Rate	$5,899.54
Rate for Payer: Cash Price	$3,649.20
Rate for Payer: Hawaii Western Management Group Commercial	$4,257.40
Rate for Payer: Health Management Network Commercial	$5,169.70
Rate for Payer: Kaiser Permanente Commercial	$5,473.80
Rate for Payer: MDX Hawaii PPO	$5,899.54
Rate for Payer: University Health Alliance Commercial	$3,405.92

NAIL FEMORAL GT RT 2333-1032S

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,725.52
Max. Negotiated Rate	$4,720.99
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL GT RT 2333-1032S

Facility

$4,867.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,433.50
Max. Negotiated Rate	$4,720.99
Rate for Payer: AlohaCare Medicaid	$2,433.50
Rate for Payer: AlohaCare Medicare	$3,698.92
Rate for Payer: Cash Price	$2,920.20
Rate for Payer: Devoted Health Medicare	$4,088.28
Rate for Payer: Hawaii Medical Service Association Medicare	$3,698.92
Rate for Payer: Hawaii Western Management Group Commercial	$3,406.90
Rate for Payer: Health Management Network Commercial	$4,136.95
Rate for Payer: Humana Medicare	$3,698.92
Rate for Payer: Kaiser Permanente Commercial	$4,380.30
Rate for Payer: Kaiser Permanente Medicaid	$2,482.17
Rate for Payer: Kaiser Permanente Medicare	$3,698.92
Rate for Payer: MDX Hawaii PPO	$4,720.99
Rate for Payer: Ohana Health Plan Medicaid	$3,698.92
Rate for Payer: Ohana Health Plan Medicare	$3,698.92
Rate for Payer: UnitedHealthcare Medicare	$3,698.92
Rate for Payer: University Health Alliance Commercial	$2,725.52

NAIL FEMORAL RETRO 2339-1138S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,731.50
Max. Negotiated Rate	$5,299.11
Rate for Payer: AlohaCare Medicaid	$2,731.50
Rate for Payer: AlohaCare Medicare	$4,151.88
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Devoted Health Medicare	$4,588.92
Rate for Payer: Hawaii Medical Service Association Medicare	$4,151.88
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Humana Medicare	$4,151.88
Rate for Payer: Kaiser Permanente Commercial	$4,916.70
Rate for Payer: Kaiser Permanente Medicaid	$2,786.13
Rate for Payer: Kaiser Permanente Medicare	$4,151.88
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: Ohana Health Plan Medicaid	$4,151.88
Rate for Payer: Ohana Health Plan Medicare	$4,151.88
Rate for Payer: UnitedHealthcare Medicare	$4,151.88
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL RETRO 2339-1138S

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Kaiser Permanente Commercial	$4,916.70
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

NAIL FEMORAL RETROGRADE

Facility

$5,463.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,059.28
Max. Negotiated Rate	$5,299.11
Rate for Payer: Cash Price	$3,277.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,824.10
Rate for Payer: Health Management Network Commercial	$4,643.55
Rate for Payer: Kaiser Permanente Commercial	$4,916.70
Rate for Payer: MDX Hawaii PPO	$5,299.11
Rate for Payer: University Health Alliance Commercial	$3,059.28

Know your out-of-pocket cost for care.

All Charges