Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

NAIL TIBIAL 9/270 #04.004.334S

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 9/285 #04.004.337S

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: MDX Hawaii PPO	$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: University Health Alliance Commercial	$2,035.60

NAIL TIBIAL 9/285 #04.004.337S

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 9/300 #04.004.340S

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 9/300 #04.004.340S

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 9/315 #04.004.343S

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 9/315 #04.004.343S

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 9/330 #04.004.346S

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 9/330 #04.004.346S

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 9/345 #04.004.349S

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 9/345 #04.004.349S

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 9/360 #04.004.352S

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 9/360 #04.004.352S

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 9/375 #04.004.355S

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 9/375 #04.004.355S

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 9/390 #04.004.358S

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 9/390 #04.004.358S

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 9X300 2341-0930S

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 9X300 2341-0930S

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 9X330 2341-0933S

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 9X330 2341-0933S

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 9X345MM 2341-0934S

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 9X345MM 2341-0934S

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 9X375MM 2341-0937S

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 9X375MM 2341-0937S

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

Know your out-of-pocket cost for care.

All Charges