Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NAIL TIBIAL 10X285MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: AlohaCare Medicaid	$2,050.00
Rate for Payer: AlohaCare Medicare	$3,116.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Devoted Health Medicare	$3,444.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,116.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Humana Medicare	$3,116.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: Kaiser Permanente Medicaid	$2,091.00
Rate for Payer: Kaiser Permanente Medicare	$3,116.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: Ohana Health Plan Medicaid	$3,116.00
Rate for Payer: Ohana Health Plan Medicare	$3,116.00
Rate for Payer: UnitedHealthcare Medicare	$3,116.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 10X285MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,296.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 10X315 2341-1031S

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: AlohaCare Medicaid	$2,050.00
Rate for Payer: AlohaCare Medicare	$3,116.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Devoted Health Medicare	$3,444.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,116.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Humana Medicare	$3,116.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: Kaiser Permanente Medicaid	$2,091.00
Rate for Payer: Kaiser Permanente Medicare	$3,116.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: Ohana Health Plan Medicaid	$3,116.00
Rate for Payer: Ohana Health Plan Medicare	$3,116.00
Rate for Payer: UnitedHealthcare Medicare	$3,116.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 10X315 2341-1031S

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,296.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 10X345 2341-1034S

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,562.50
Max. Negotiated Rate	$4,971.25
Rate for Payer: AlohaCare Medicaid	$2,562.50
Rate for Payer: AlohaCare Medicare	$3,895.00
Rate for Payer: Cash Price	$3,075.00
Rate for Payer: Devoted Health Medicare	$4,305.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,895.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,587.50
Rate for Payer: Health Management Network Commercial	$4,356.25
Rate for Payer: Humana Medicare	$3,895.00
Rate for Payer: Kaiser Permanente Commercial	$4,612.50
Rate for Payer: Kaiser Permanente Medicaid	$2,613.75
Rate for Payer: Kaiser Permanente Medicare	$3,895.00
Rate for Payer: MDX Hawaii PPO	$4,971.25
Rate for Payer: Ohana Health Plan Medicaid	$3,895.00
Rate for Payer: Ohana Health Plan Medicare	$3,895.00
Rate for Payer: UnitedHealthcare Medicare	$3,895.00
Rate for Payer: University Health Alliance Commercial	$2,870.00

NAIL TIBIAL 10X345 2341-1034S

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,870.00
Max. Negotiated Rate	$4,971.25
Rate for Payer: Cash Price	$3,075.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,587.50
Rate for Payer: Health Management Network Commercial	$4,356.25
Rate for Payer: Kaiser Permanente Commercial	$4,612.50
Rate for Payer: MDX Hawaii PPO	$4,971.25
Rate for Payer: University Health Alliance Commercial	$2,870.00

NAIL TIBIAL 10X360MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,296.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 10X360MM

Facility

$4,100.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$3,977.00
Rate for Payer: AlohaCare Medicaid	$2,050.00
Rate for Payer: AlohaCare Medicare	$3,116.00
Rate for Payer: Cash Price	$2,460.00
Rate for Payer: Devoted Health Medicare	$3,444.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,116.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,870.00
Rate for Payer: Health Management Network Commercial	$3,485.00
Rate for Payer: Humana Medicare	$3,116.00
Rate for Payer: Kaiser Permanente Commercial	$3,690.00
Rate for Payer: Kaiser Permanente Medicaid	$2,091.00
Rate for Payer: Kaiser Permanente Medicare	$3,116.00
Rate for Payer: MDX Hawaii PPO	$3,977.00
Rate for Payer: Ohana Health Plan Medicaid	$3,116.00
Rate for Payer: Ohana Health Plan Medicare	$3,116.00
Rate for Payer: UnitedHealthcare Medicare	$3,116.00
Rate for Payer: University Health Alliance Commercial	$2,296.00

NAIL TIBIAL 10X390 2341-1039S

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,562.50
Max. Negotiated Rate	$4,971.25
Rate for Payer: AlohaCare Medicaid	$2,562.50
Rate for Payer: AlohaCare Medicare	$3,895.00
Rate for Payer: Cash Price	$3,075.00
Rate for Payer: Devoted Health Medicare	$4,305.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,895.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,587.50
Rate for Payer: Health Management Network Commercial	$4,356.25
Rate for Payer: Humana Medicare	$3,895.00
Rate for Payer: Kaiser Permanente Commercial	$4,612.50
Rate for Payer: Kaiser Permanente Medicaid	$2,613.75
Rate for Payer: Kaiser Permanente Medicare	$3,895.00
Rate for Payer: MDX Hawaii PPO	$4,971.25
Rate for Payer: Ohana Health Plan Medicaid	$3,895.00
Rate for Payer: Ohana Health Plan Medicare	$3,895.00
Rate for Payer: UnitedHealthcare Medicare	$3,895.00
Rate for Payer: University Health Alliance Commercial	$2,870.00

NAIL TIBIAL 10X390 2341-1039S

Facility

$5,125.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,870.00
Max. Negotiated Rate	$4,971.25
Rate for Payer: Cash Price	$3,075.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,587.50
Rate for Payer: Health Management Network Commercial	$4,356.25
Rate for Payer: Kaiser Permanente Commercial	$4,612.50
Rate for Payer: MDX Hawaii PPO	$4,971.25
Rate for Payer: University Health Alliance Commercial	$2,870.00

NAIL TIBIAL 11/285 04.004.537S

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: AlohaCare Medicaid	$1,875.00
Rate for Payer: AlohaCare Medicare	$2,850.00
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Devoted Health Medicare	$3,150.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,850.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Humana Medicare	$2,850.00
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: Kaiser Permanente Medicaid	$1,912.50
Rate for Payer: Kaiser Permanente Medicare	$2,850.00
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: Ohana Health Plan Medicaid	$2,850.00
Rate for Payer: Ohana Health Plan Medicare	$2,850.00
Rate for Payer: UnitedHealthcare Medicare	$2,850.00
Rate for Payer: University Health Alliance Commercial	$2,100.00

NAIL TIBIAL 11/285 04.004.537S

Facility

$3,750.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$3,637.50
Rate for Payer: Cash Price	$2,250.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,625.00
Rate for Payer: Health Management Network Commercial	$3,187.50
Rate for Payer: Kaiser Permanente Commercial	$3,375.00
Rate for Payer: MDX Hawaii PPO	$3,637.50
Rate for Payer: University Health Alliance Commercial	$2,100.00

NAIL TIBIAL 11/300 04.004.540S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.50
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$2,762.60
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$3,053.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,762.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$2,762.60
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$2,762.60
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$2,762.60
Rate for Payer: Ohana Health Plan Medicare	$2,762.60
Rate for Payer: UnitedHealthcare Medicare	$2,762.60
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 11/300 04.004.540S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 11/315 04.004.543S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 11/315 04.004.543S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.50
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$2,762.60
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$3,053.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,762.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$2,762.60
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$2,762.60
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$2,762.60
Rate for Payer: Ohana Health Plan Medicare	$2,762.60
Rate for Payer: UnitedHealthcare Medicare	$2,762.60
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 11/330 04.004.546S

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

NAIL TIBIAL 11/330 04.004.546S

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$3,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

NAIL TIBIAL 11/345 04.004.549S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,817.50
Max. Negotiated Rate	$3,525.95
Rate for Payer: AlohaCare Medicaid	$1,817.50
Rate for Payer: AlohaCare Medicare	$2,762.60
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Devoted Health Medicare	$3,053.40
Rate for Payer: Hawaii Medical Service Association Medicare	$2,762.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Humana Medicare	$2,762.60
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: Kaiser Permanente Medicaid	$1,853.85
Rate for Payer: Kaiser Permanente Medicare	$2,762.60
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: Ohana Health Plan Medicaid	$2,762.60
Rate for Payer: Ohana Health Plan Medicare	$2,762.60
Rate for Payer: UnitedHealthcare Medicare	$2,762.60
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 11/345 04.004.549S

Facility

$3,635.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,035.60
Max. Negotiated Rate	$3,525.95
Rate for Payer: Cash Price	$2,181.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,544.50
Rate for Payer: Health Management Network Commercial	$3,089.75
Rate for Payer: Kaiser Permanente Commercial	$3,271.50
Rate for Payer: MDX Hawaii PPO	$3,525.95
Rate for Payer: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 11/360 04.004.552S

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

NAIL TIBIAL 11/360 04.004.552S

Facility

$4,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$3,880.00
Rate for Payer: AlohaCare Medicaid	$2,000.00
Rate for Payer: AlohaCare Medicare	$3,040.00
Rate for Payer: Cash Price	$2,400.00
Rate for Payer: Devoted Health Medicare	$3,360.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,040.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,800.00
Rate for Payer: Health Management Network Commercial	$3,400.00
Rate for Payer: Humana Medicare	$3,040.00
Rate for Payer: Kaiser Permanente Commercial	$3,600.00
Rate for Payer: Kaiser Permanente Medicaid	$2,040.00
Rate for Payer: Kaiser Permanente Medicare	$3,040.00
Rate for Payer: MDX Hawaii PPO	$3,880.00
Rate for Payer: Ohana Health Plan Medicaid	$3,040.00
Rate for Payer: Ohana Health Plan Medicare	$3,040.00
Rate for Payer: UnitedHealthcare Medicare	$3,040.00
Rate for Payer: University Health Alliance Commercial	$2,240.00

NAIL TIBIAL 11/375 04.004.555S

Facility

$5,268.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,634.00
Max. Negotiated Rate	$5,109.96
Rate for Payer: AlohaCare Medicaid	$2,634.00
Rate for Payer: AlohaCare Medicare	$4,003.68
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Devoted Health Medicare	$4,425.12
Rate for Payer: Hawaii Medical Service Association Medicare	$4,003.68
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Humana Medicare	$4,003.68
Rate for Payer: Kaiser Permanente Commercial	$4,741.20
Rate for Payer: Kaiser Permanente Medicaid	$2,686.68
Rate for Payer: Kaiser Permanente Medicare	$4,003.68
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: Ohana Health Plan Medicaid	$4,003.68
Rate for Payer: Ohana Health Plan Medicare	$4,003.68
Rate for Payer: UnitedHealthcare Medicare	$4,003.68
Rate for Payer: University Health Alliance Commercial	$2,950.08

NAIL TIBIAL 11/375 04.004.555S

Facility

$5,268.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,950.08
Max. Negotiated Rate	$5,109.96
Rate for Payer: Cash Price	$3,160.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,687.60
Rate for Payer: Health Management Network Commercial	$4,477.80
Rate for Payer: Kaiser Permanente Commercial	$4,741.20
Rate for Payer: MDX Hawaii PPO	$5,109.96
Rate for Payer: University Health Alliance Commercial	$2,950.08

NAIL TIBIAL 11/390 04.004.558S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,966.72
Max. Negotiated Rate	$3,406.64
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: University Health Alliance Commercial	$1,966.72

Know your out-of-pocket cost for care.

All Charges