Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NAIL TIBIAL 12/405 04.004.661S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,756.00
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$2,669.12
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$2,950.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,669.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$2,669.12
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$2,669.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$2,669.12
Rate for Payer: Ohana Health Plan Medicare	$2,669.12
Rate for Payer: UnitedHealthcare Medicare	$2,669.12
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 12/405 04.004.661S

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

NAIL TIBIAL 12/420 04.004.664S

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

NAIL TIBIAL 12/420 04.004.664S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,756.00
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$2,669.12
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$2,950.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,669.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$2,669.12
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$2,669.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$2,669.12
Rate for Payer: Ohana Health Plan Medicare	$2,669.12
Rate for Payer: UnitedHealthcare Medicare	$2,669.12
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 2341-0931S

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 2341-0931S

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 8/285 #04.004.237S

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 8/285 #04.004.237S

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 8/300 #04.004.240S

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

NAIL TIBIAL 8/300 #04.004.240S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,756.00
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$2,669.12
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$2,950.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,669.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$2,669.12
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$2,669.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$2,669.12
Rate for Payer: Ohana Health Plan Medicare	$2,669.12
Rate for Payer: UnitedHealthcare Medicare	$2,669.12
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 8/315 #04.004.243S

Facility

$4,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.80
Max. Negotiated Rate	$4,442.60
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: Kaiser Permanente Commercial	$4,122.00
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: University Health Alliance Commercial	$2,564.80

NAIL TIBIAL 8/315 #04.004.243S

Facility

$4,580.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,290.00
Max. Negotiated Rate	$4,442.60
Rate for Payer: AlohaCare Medicaid	$2,290.00
Rate for Payer: AlohaCare Medicare	$3,480.80
Rate for Payer: Cash Price	$2,748.00
Rate for Payer: Devoted Health Medicare	$3,847.20
Rate for Payer: Hawaii Medical Service Association Medicare	$3,480.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,206.00
Rate for Payer: Health Management Network Commercial	$3,893.00
Rate for Payer: Humana Medicare	$3,480.80
Rate for Payer: Kaiser Permanente Commercial	$4,122.00
Rate for Payer: Kaiser Permanente Medicaid	$2,335.80
Rate for Payer: Kaiser Permanente Medicare	$3,480.80
Rate for Payer: MDX Hawaii PPO	$4,442.60
Rate for Payer: Ohana Health Plan Medicaid	$3,480.80
Rate for Payer: Ohana Health Plan Medicare	$3,480.80
Rate for Payer: UnitedHealthcare Medicare	$3,480.80
Rate for Payer: University Health Alliance Commercial	$2,564.80

NAIL TIBIAL 8/330 #04.004.246S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,756.00
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$2,669.12
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$2,950.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,669.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$2,669.12
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$2,669.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$2,669.12
Rate for Payer: Ohana Health Plan Medicare	$2,669.12
Rate for Payer: UnitedHealthcare Medicare	$2,669.12
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 8/330 #04.004.246S

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

NAIL TIBIAL 8/345 #04.004.249S

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 8/345 #04.004.249S

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 8/360 #04.004.252S

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 8/360 #04.004.252S

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 8/375 #04.004.255S

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 8/375 #04.004.255S

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 8/390 #04.004.258S

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

NAIL TIBIAL 8/390 #04.004.258S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,756.00
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$2,669.12
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$2,950.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,669.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$2,669.12
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$2,669.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$2,669.12
Rate for Payer: Ohana Health Plan Medicare	$2,669.12
Rate for Payer: UnitedHealthcare Medicare	$2,669.12
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 9/255 #04.004.331S

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

NAIL TIBIAL 9/255 #04.004.331S

Facility

$3,512.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,756.00
Max. Negotiated Rate	$3,406.64
Rate for Payer: AlohaCare Medicaid	$1,756.00
Rate for Payer: AlohaCare Medicare	$2,669.12
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Devoted Health Medicare	$2,950.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,669.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,458.40
Rate for Payer: Health Management Network Commercial	$2,985.20
Rate for Payer: Humana Medicare	$2,669.12
Rate for Payer: Kaiser Permanente Commercial	$3,160.80
Rate for Payer: Kaiser Permanente Medicaid	$1,791.12
Rate for Payer: Kaiser Permanente Medicare	$2,669.12
Rate for Payer: MDX Hawaii PPO	$3,406.64
Rate for Payer: Ohana Health Plan Medicaid	$2,669.12
Rate for Payer: Ohana Health Plan Medicare	$2,669.12
Rate for Payer: UnitedHealthcare Medicare	$2,669.12
Rate for Payer: University Health Alliance Commercial	$1,966.72

NAIL TIBIAL 9/270 #04.004.334S

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

Know your out-of-pocket cost for care.

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