Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NAIL FEMORAL RETROGRADE

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 RETROGRADE 13X340

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 RETROGRADE 13X340

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 FEMOR RETRGRDE 2339-1036S

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 FEMOR RETRGRDE 2339-1036S

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 FEMOR RETRGRDE 2339-1136S

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 FEMOR RETRGRDE 2339-1136S

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 FEMUR 10X380 04.003.356S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,903.00
Max. Negotiated Rate	$3,691.82
Rate for Payer: AlohaCare Medicaid	$1,903.00
Rate for Payer: AlohaCare Medicare	$2,892.56
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Devoted Health Medicare	$3,197.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,892.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: Humana Medicare	$2,892.56
Rate for Payer: Kaiser Permanente Commercial	$3,425.40
Rate for Payer: Kaiser Permanente Medicaid	$1,941.06
Rate for Payer: Kaiser Permanente Medicare	$2,892.56
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: Ohana Health Plan Medicaid	$2,892.56
Rate for Payer: Ohana Health Plan Medicare	$2,892.56
Rate for Payer: UnitedHealthcare Medicare	$2,892.56
Rate for Payer: University Health Alliance Commercial	$2,131.36

NAIL FEMUR 10X380 04.003.356S

Facility

$3,806.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,131.36
Max. Negotiated Rate	$3,691.82
Rate for Payer: Cash Price	$2,283.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,664.20
Rate for Payer: Health Management Network Commercial	$3,235.10
Rate for Payer: Kaiser Permanente Commercial	$3,425.40
Rate for Payer: MDX Hawaii PPO	$3,691.82
Rate for Payer: University Health Alliance Commercial	$2,131.36

NAIL FR GAMMA 3130-0170S

Facility

$4,730.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,365.00
Max. Negotiated Rate	$4,588.10
Rate for Payer: AlohaCare Medicaid	$2,365.00
Rate for Payer: AlohaCare Medicare	$3,594.80
Rate for Payer: Cash Price	$2,838.00
Rate for Payer: Devoted Health Medicare	$3,973.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,594.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,311.00
Rate for Payer: Health Management Network Commercial	$4,020.50
Rate for Payer: Humana Medicare	$3,594.80
Rate for Payer: Kaiser Permanente Commercial	$4,257.00
Rate for Payer: Kaiser Permanente Medicaid	$2,412.30
Rate for Payer: Kaiser Permanente Medicare	$3,594.80
Rate for Payer: MDX Hawaii PPO	$4,588.10
Rate for Payer: Ohana Health Plan Medicaid	$3,594.80
Rate for Payer: Ohana Health Plan Medicare	$3,594.80
Rate for Payer: UnitedHealthcare Medicare	$3,594.80
Rate for Payer: University Health Alliance Commercial	$2,648.80

NAIL FR GAMMA 3130-0170S

Facility

$4,730.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,648.80
Max. Negotiated Rate	$4,588.10
Rate for Payer: Cash Price	$2,838.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,311.00
Rate for Payer: Health Management Network Commercial	$4,020.50
Rate for Payer: Kaiser Permanente Commercial	$4,257.00
Rate for Payer: MDX Hawaii PPO	$4,588.10
Rate for Payer: University Health Alliance Commercial	$2,648.80

NAIL FRMORAL GT RT 2333-1036S

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 FRMORAL GT RT 2333-1036S

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 GAMMA 12X170 8125-2170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,390.50
Max. Negotiated Rate	$4,637.57
Rate for Payer: AlohaCare Medicaid	$2,390.50
Rate for Payer: AlohaCare Medicare	$3,633.56
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Devoted Health Medicare	$4,016.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3,633.56
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Humana Medicare	$3,633.56
Rate for Payer: Kaiser Permanente Commercial	$4,302.90
Rate for Payer: Kaiser Permanente Medicaid	$2,438.31
Rate for Payer: Kaiser Permanente Medicare	$3,633.56
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: Ohana Health Plan Medicaid	$3,633.56
Rate for Payer: Ohana Health Plan Medicare	$3,633.56
Rate for Payer: UnitedHealthcare Medicare	$3,633.56
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL GAMMA 12X170 8125-2170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.36
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Kaiser Permanente Commercial	$4,302.90
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL GAMMA4 12X300 8425-2300S

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,230.00
Max. Negotiated Rate	$6,266.20
Rate for Payer: AlohaCare Medicaid	$3,230.00
Rate for Payer: AlohaCare Medicare	$4,909.60
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Devoted Health Medicare	$5,426.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,909.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Humana Medicare	$4,909.60
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: Kaiser Permanente Medicaid	$3,294.60
Rate for Payer: Kaiser Permanente Medicare	$4,909.60
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: Ohana Health Plan Medicaid	$4,909.60
Rate for Payer: Ohana Health Plan Medicare	$4,909.60
Rate for Payer: UnitedHealthcare Medicare	$4,909.60
Rate for Payer: University Health Alliance Commercial	$3,617.60

NAIL GAMMA4 12X300 8425-2300S

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,617.60
Max. Negotiated Rate	$6,266.20
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: University Health Alliance Commercial	$3,617.60

NAIL GAMMA4 170MM 8130-9170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,390.50
Max. Negotiated Rate	$4,637.57
Rate for Payer: AlohaCare Medicaid	$2,390.50
Rate for Payer: AlohaCare Medicare	$3,633.56
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Devoted Health Medicare	$4,016.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3,633.56
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Humana Medicare	$3,633.56
Rate for Payer: Kaiser Permanente Commercial	$4,302.90
Rate for Payer: Kaiser Permanente Medicaid	$2,438.31
Rate for Payer: Kaiser Permanente Medicare	$3,633.56
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: Ohana Health Plan Medicaid	$3,633.56
Rate for Payer: Ohana Health Plan Medicare	$3,633.56
Rate for Payer: UnitedHealthcare Medicare	$3,633.56
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL GAMMA4 170MM 8130-9170S

Facility

$4,781.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,677.36
Max. Negotiated Rate	$4,637.57
Rate for Payer: Cash Price	$2,868.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,346.70
Rate for Payer: Health Management Network Commercial	$4,063.85
Rate for Payer: Kaiser Permanente Commercial	$4,302.90
Rate for Payer: MDX Hawaii PPO	$4,637.57
Rate for Payer: University Health Alliance Commercial	$2,677.36

NAIL GAMMA4 LNG LF 8525-2300S

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,617.60
Max. Negotiated Rate	$6,266.20
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: University Health Alliance Commercial	$3,617.60

NAIL GAMMA4 LNG LF 8525-2300S

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,230.00
Max. Negotiated Rate	$6,266.20
Rate for Payer: AlohaCare Medicaid	$3,230.00
Rate for Payer: AlohaCare Medicare	$4,909.60
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Devoted Health Medicare	$5,426.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,909.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Humana Medicare	$4,909.60
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: Kaiser Permanente Medicaid	$3,294.60
Rate for Payer: Kaiser Permanente Medicare	$4,909.60
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: Ohana Health Plan Medicaid	$4,909.60
Rate for Payer: Ohana Health Plan Medicare	$4,909.60
Rate for Payer: UnitedHealthcare Medicare	$4,909.60
Rate for Payer: University Health Alliance Commercial	$3,617.60

NAIL GAMMA4 LNG LF 8525-3340S

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,230.00
Max. Negotiated Rate	$6,266.20
Rate for Payer: AlohaCare Medicaid	$3,230.00
Rate for Payer: AlohaCare Medicare	$4,909.60
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Devoted Health Medicare	$5,426.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,909.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Humana Medicare	$4,909.60
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: Kaiser Permanente Medicaid	$3,294.60
Rate for Payer: Kaiser Permanente Medicare	$4,909.60
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: Ohana Health Plan Medicaid	$4,909.60
Rate for Payer: Ohana Health Plan Medicare	$4,909.60
Rate for Payer: UnitedHealthcare Medicare	$4,909.60
Rate for Payer: University Health Alliance Commercial	$3,617.60

NAIL GAMMA4 LNG LF 8525-3340S

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,617.60
Max. Negotiated Rate	$6,266.20
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: University Health Alliance Commercial	$3,617.60

NAIL GAMMA4 LNG RT

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,230.00
Max. Negotiated Rate	$6,266.20
Rate for Payer: AlohaCare Medicaid	$3,230.00
Rate for Payer: AlohaCare Medicare	$4,909.60
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Devoted Health Medicare	$5,426.40
Rate for Payer: Hawaii Medical Service Association Medicare	$4,909.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Humana Medicare	$4,909.60
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: Kaiser Permanente Medicaid	$3,294.60
Rate for Payer: Kaiser Permanente Medicare	$4,909.60
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: Ohana Health Plan Medicaid	$4,909.60
Rate for Payer: Ohana Health Plan Medicare	$4,909.60
Rate for Payer: UnitedHealthcare Medicare	$4,909.60
Rate for Payer: University Health Alliance Commercial	$3,617.60

NAIL GAMMA4 LNG RT

Facility

$6,460.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,617.60
Max. Negotiated Rate	$6,266.20
Rate for Payer: Cash Price	$3,876.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,522.00
Rate for Payer: Health Management Network Commercial	$5,491.00
Rate for Payer: Kaiser Permanente Commercial	$5,814.00
Rate for Payer: MDX Hawaii PPO	$6,266.20
Rate for Payer: University Health Alliance Commercial	$3,617.60

Know your out-of-pocket cost for care.

All Charges