Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE 2.7MM OBL LT 2H 249.687

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$899.36
Max. Negotiated Rate	$1,557.82
Rate for Payer: Cash Price	$963.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: University Health Alliance Commercial	$899.36

PLATE 2.7MM OBL RT 2H 249.686

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$899.36
Max. Negotiated Rate	$1,557.82
Rate for Payer: Cash Price	$963.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: University Health Alliance Commercial	$899.36

PLATE 2.7MM OBL RT 2H 249.686

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$803.00
Max. Negotiated Rate	$1,557.82
Rate for Payer: AlohaCare Medicaid	$803.00
Rate for Payer: AlohaCare Medicare	$1,220.56
Rate for Payer: Cash Price	$963.60
Rate for Payer: Devoted Health Medicare	$1,349.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,220.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Humana Medicare	$1,220.56
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: Kaiser Permanente Medicaid	$819.06
Rate for Payer: Kaiser Permanente Medicare	$1,220.56
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: Ohana Health Plan Medicaid	$1,220.56
Rate for Payer: Ohana Health Plan Medicare	$1,220.56
Rate for Payer: UnitedHealthcare Medicare	$1,220.56
Rate for Payer: University Health Alliance Commercial	$899.36

PLATE 2.7MM RT 2H 249.688

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$899.36
Max. Negotiated Rate	$1,557.82
Rate for Payer: Cash Price	$963.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: University Health Alliance Commercial	$899.36

PLATE 2.7MM RT 2H 249.688

Facility

$1,606.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$803.00
Max. Negotiated Rate	$1,557.82
Rate for Payer: AlohaCare Medicaid	$803.00
Rate for Payer: AlohaCare Medicare	$1,220.56
Rate for Payer: Cash Price	$963.60
Rate for Payer: Devoted Health Medicare	$1,349.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,220.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,124.20
Rate for Payer: Health Management Network Commercial	$1,365.10
Rate for Payer: Humana Medicare	$1,220.56
Rate for Payer: Kaiser Permanente Commercial	$1,445.40
Rate for Payer: Kaiser Permanente Medicaid	$819.06
Rate for Payer: Kaiser Permanente Medicare	$1,220.56
Rate for Payer: MDX Hawaii PPO	$1,557.82
Rate for Payer: Ohana Health Plan Medicaid	$1,220.56
Rate for Payer: Ohana Health Plan Medicare	$1,220.56
Rate for Payer: UnitedHealthcare Medicare	$1,220.56
Rate for Payer: University Health Alliance Commercial	$899.36

PLATE 2.7 NARR LOK 8H 629728

Facility

$2,614.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,463.84
Max. Negotiated Rate	$2,535.58
Rate for Payer: Cash Price	$1,568.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,829.80
Rate for Payer: Health Management Network Commercial	$2,221.90
Rate for Payer: Kaiser Permanente Commercial	$2,352.60
Rate for Payer: MDX Hawaii PPO	$2,535.58
Rate for Payer: University Health Alliance Commercial	$1,463.84

PLATE 2.7 NARR LOK 8H 629728

Facility

$2,614.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,307.00
Max. Negotiated Rate	$2,535.58
Rate for Payer: AlohaCare Medicaid	$1,307.00
Rate for Payer: AlohaCare Medicare	$1,986.64
Rate for Payer: Cash Price	$1,568.40
Rate for Payer: Devoted Health Medicare	$2,195.76
Rate for Payer: Hawaii Medical Service Association Medicare	$1,986.64
Rate for Payer: Hawaii Western Management Group Commercial	$1,829.80
Rate for Payer: Health Management Network Commercial	$2,221.90
Rate for Payer: Humana Medicare	$1,986.64
Rate for Payer: Kaiser Permanente Commercial	$2,352.60
Rate for Payer: Kaiser Permanente Medicaid	$1,333.14
Rate for Payer: Kaiser Permanente Medicare	$1,986.64
Rate for Payer: MDX Hawaii PPO	$2,535.58
Rate for Payer: Ohana Health Plan Medicaid	$1,986.64
Rate for Payer: Ohana Health Plan Medicare	$1,986.64
Rate for Payer: UnitedHealthcare Medicare	$1,986.64
Rate for Payer: University Health Alliance Commercial	$1,463.84

PLATE 2.7 NARR T-PLATE 629782

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,369.76
Max. Negotiated Rate	$2,372.62
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Kaiser Permanente Commercial	$2,201.40
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: University Health Alliance Commercial	$1,369.76

PLATE 2.7 NARR T-PLATE 629782

Facility

$2,446.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,223.00
Max. Negotiated Rate	$2,372.62
Rate for Payer: AlohaCare Medicaid	$1,223.00
Rate for Payer: AlohaCare Medicare	$1,858.96
Rate for Payer: Cash Price	$1,467.60
Rate for Payer: Devoted Health Medicare	$2,054.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,858.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,712.20
Rate for Payer: Health Management Network Commercial	$2,079.10
Rate for Payer: Humana Medicare	$1,858.96
Rate for Payer: Kaiser Permanente Commercial	$2,201.40
Rate for Payer: Kaiser Permanente Medicaid	$1,247.46
Rate for Payer: Kaiser Permanente Medicare	$1,858.96
Rate for Payer: MDX Hawaii PPO	$2,372.62
Rate for Payer: Ohana Health Plan Medicaid	$1,858.96
Rate for Payer: Ohana Health Plan Medicare	$1,858.96
Rate for Payer: UnitedHealthcare Medicare	$1,858.96
Rate for Payer: University Health Alliance Commercial	$1,369.76

PLATE 2.7 VA-LCK RT 02.211.400

Facility

$2,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,276.80
Max. Negotiated Rate	$2,211.60
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: University Health Alliance Commercial	$1,276.80

PLATE 2.7 VA-LCK RT 02.211.400

Facility

$2,280.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,140.00
Max. Negotiated Rate	$2,211.60
Rate for Payer: AlohaCare Medicaid	$1,140.00
Rate for Payer: AlohaCare Medicare	$1,732.80
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: Devoted Health Medicare	$1,915.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,732.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,596.00
Rate for Payer: Health Management Network Commercial	$1,938.00
Rate for Payer: Humana Medicare	$1,732.80
Rate for Payer: Kaiser Permanente Commercial	$2,052.00
Rate for Payer: Kaiser Permanente Medicaid	$1,162.80
Rate for Payer: Kaiser Permanente Medicare	$1,732.80
Rate for Payer: MDX Hawaii PPO	$2,211.60
Rate for Payer: Ohana Health Plan Medicaid	$1,732.80
Rate for Payer: Ohana Health Plan Medicare	$1,732.80
Rate for Payer: UnitedHealthcare Medicare	$1,732.80
Rate for Payer: University Health Alliance Commercial	$1,276.80

PLATE 2.7X2MM STEP 336-2722

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,493.52
Max. Negotiated Rate	$2,586.99
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE 2.7X2MM STEP 336-2722

Facility

$2,667.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.50
Max. Negotiated Rate	$2,586.99
Rate for Payer: AlohaCare Medicaid	$1,333.50
Rate for Payer: AlohaCare Medicare	$2,026.92
Rate for Payer: Cash Price	$1,600.20
Rate for Payer: Devoted Health Medicare	$2,240.28
Rate for Payer: Hawaii Medical Service Association Medicare	$2,026.92
Rate for Payer: Hawaii Western Management Group Commercial	$1,866.90
Rate for Payer: Health Management Network Commercial	$2,266.95
Rate for Payer: Humana Medicare	$2,026.92
Rate for Payer: Kaiser Permanente Commercial	$2,400.30
Rate for Payer: Kaiser Permanente Medicaid	$1,360.17
Rate for Payer: Kaiser Permanente Medicare	$2,026.92
Rate for Payer: MDX Hawaii PPO	$2,586.99
Rate for Payer: Ohana Health Plan Medicaid	$2,026.92
Rate for Payer: Ohana Health Plan Medicare	$2,026.92
Rate for Payer: UnitedHealthcare Medicare	$2,026.92
Rate for Payer: University Health Alliance Commercial	$1,493.52

PLATE 2H/LT/85MM 02.117.702

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,588.72
Max. Negotiated Rate	$2,751.89
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: Kaiser Permanente Commercial	$2,553.30
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: University Health Alliance Commercial	$1,588.72

PLATE 2H/LT/85MM 02.117.702

Facility

$2,837.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,418.50
Max. Negotiated Rate	$2,751.89
Rate for Payer: AlohaCare Medicaid	$1,418.50
Rate for Payer: AlohaCare Medicare	$2,156.12
Rate for Payer: Cash Price	$1,702.20
Rate for Payer: Devoted Health Medicare	$2,383.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,156.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,985.90
Rate for Payer: Health Management Network Commercial	$2,411.45
Rate for Payer: Humana Medicare	$2,156.12
Rate for Payer: Kaiser Permanente Commercial	$2,553.30
Rate for Payer: Kaiser Permanente Medicaid	$1,446.87
Rate for Payer: Kaiser Permanente Medicare	$2,156.12
Rate for Payer: MDX Hawaii PPO	$2,751.89
Rate for Payer: Ohana Health Plan Medicaid	$2,156.12
Rate for Payer: Ohana Health Plan Medicare	$2,156.12
Rate for Payer: UnitedHealthcare Medicare	$2,156.12
Rate for Payer: University Health Alliance Commercial	$1,588.72

PLATE 2H SYNDESMOS AR-8959-01S

Facility

$2,834.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,417.00
Max. Negotiated Rate	$2,748.98
Rate for Payer: AlohaCare Medicaid	$1,417.00
Rate for Payer: AlohaCare Medicare	$2,153.84
Rate for Payer: Cash Price	$1,700.40
Rate for Payer: Devoted Health Medicare	$2,380.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,153.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,983.80
Rate for Payer: Health Management Network Commercial	$2,408.90
Rate for Payer: Humana Medicare	$2,153.84
Rate for Payer: Kaiser Permanente Commercial	$2,550.60
Rate for Payer: Kaiser Permanente Medicaid	$1,445.34
Rate for Payer: Kaiser Permanente Medicare	$2,153.84
Rate for Payer: MDX Hawaii PPO	$2,748.98
Rate for Payer: Ohana Health Plan Medicaid	$2,153.84
Rate for Payer: Ohana Health Plan Medicare	$2,153.84
Rate for Payer: UnitedHealthcare Medicare	$2,153.84
Rate for Payer: University Health Alliance Commercial	$1,587.04

PLATE 2H SYNDESMOS AR-8959-01S

Facility

$2,834.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,587.04
Max. Negotiated Rate	$2,748.98
Rate for Payer: Cash Price	$1,700.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,983.80
Rate for Payer: Health Management Network Commercial	$2,408.90
Rate for Payer: Kaiser Permanente Commercial	$2,550.60
Rate for Payer: MDX Hawaii PPO	$2,748.98
Rate for Payer: University Health Alliance Commercial	$1,587.04

PLATE 2X2 HOLES

Facility

$668.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$334.00
Max. Negotiated Rate	$647.96
Rate for Payer: AlohaCare Medicaid	$334.00
Rate for Payer: AlohaCare Medicare	$507.68
Rate for Payer: Cash Price	$400.80
Rate for Payer: Devoted Health Medicare	$561.12
Rate for Payer: Hawaii Medical Service Association Medicare	$507.68
Rate for Payer: Hawaii Western Management Group Commercial	$467.60
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: Humana Medicare	$507.68
Rate for Payer: Kaiser Permanente Commercial	$601.20
Rate for Payer: Kaiser Permanente Medicaid	$340.68
Rate for Payer: Kaiser Permanente Medicare	$507.68
Rate for Payer: MDX Hawaii PPO	$647.96
Rate for Payer: Ohana Health Plan Medicaid	$507.68
Rate for Payer: Ohana Health Plan Medicare	$507.68
Rate for Payer: UnitedHealthcare Medicare	$507.68
Rate for Payer: University Health Alliance Commercial	$374.08

PLATE 2X2 HOLES

Facility

$668.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$374.08
Max. Negotiated Rate	$647.96
Rate for Payer: Cash Price	$400.80
Rate for Payer: Hawaii Western Management Group Commercial	$467.60
Rate for Payer: Health Management Network Commercial	$567.80
Rate for Payer: Kaiser Permanente Commercial	$601.20
Rate for Payer: MDX Hawaii PPO	$647.96
Rate for Payer: University Health Alliance Commercial	$374.08

PLATE 3.2MM CLAV HOOK 241.073S

Facility

$2,937.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,644.72
Max. Negotiated Rate	$2,848.89
Rate for Payer: Cash Price	$1,762.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,055.90
Rate for Payer: Health Management Network Commercial	$2,496.45
Rate for Payer: Kaiser Permanente Commercial	$2,643.30
Rate for Payer: MDX Hawaii PPO	$2,848.89
Rate for Payer: University Health Alliance Commercial	$1,644.72

PLATE 3.2MM CLAV HOOK 241.073S

Facility

$2,937.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,468.50
Max. Negotiated Rate	$2,848.89
Rate for Payer: AlohaCare Medicaid	$1,468.50
Rate for Payer: AlohaCare Medicare	$2,232.12
Rate for Payer: Cash Price	$1,762.20
Rate for Payer: Devoted Health Medicare	$2,467.08
Rate for Payer: Hawaii Medical Service Association Medicare	$2,232.12
Rate for Payer: Hawaii Western Management Group Commercial	$2,055.90
Rate for Payer: Health Management Network Commercial	$2,496.45
Rate for Payer: Humana Medicare	$2,232.12
Rate for Payer: Kaiser Permanente Commercial	$2,643.30
Rate for Payer: Kaiser Permanente Medicaid	$1,497.87
Rate for Payer: Kaiser Permanente Medicare	$2,232.12
Rate for Payer: MDX Hawaii PPO	$2,848.89
Rate for Payer: Ohana Health Plan Medicaid	$2,232.12
Rate for Payer: Ohana Health Plan Medicare	$2,232.12
Rate for Payer: UnitedHealthcare Medicare	$2,232.12
Rate for Payer: University Health Alliance Commercial	$1,644.72

PLATE 3.5 4-HOLE/51MM 223.54

Facility

$1,246.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$697.76
Max. Negotiated Rate	$1,208.62
Rate for Payer: Cash Price	$747.60
Rate for Payer: Hawaii Western Management Group Commercial	$872.20
Rate for Payer: Health Management Network Commercial	$1,059.10
Rate for Payer: Kaiser Permanente Commercial	$1,121.40
Rate for Payer: MDX Hawaii PPO	$1,208.62
Rate for Payer: University Health Alliance Commercial	$697.76

PLATE 3.5 4-HOLE/51MM 223.54

Facility

$1,246.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$623.00
Max. Negotiated Rate	$1,208.62
Rate for Payer: AlohaCare Medicaid	$623.00
Rate for Payer: AlohaCare Medicare	$946.96
Rate for Payer: Cash Price	$747.60
Rate for Payer: Devoted Health Medicare	$1,046.64
Rate for Payer: Hawaii Medical Service Association Medicare	$946.96
Rate for Payer: Hawaii Western Management Group Commercial	$872.20
Rate for Payer: Health Management Network Commercial	$1,059.10
Rate for Payer: Humana Medicare	$946.96
Rate for Payer: Kaiser Permanente Commercial	$1,121.40
Rate for Payer: Kaiser Permanente Medicaid	$635.46
Rate for Payer: Kaiser Permanente Medicare	$946.96
Rate for Payer: MDX Hawaii PPO	$1,208.62
Rate for Payer: Ohana Health Plan Medicaid	$946.96
Rate for Payer: Ohana Health Plan Medicare	$946.96
Rate for Payer: UnitedHealthcare Medicare	$946.96
Rate for Payer: University Health Alliance Commercial	$697.76

PLATE 3.5 5-HOLE/64MM 223.55

Facility

$1,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$719.60
Max. Negotiated Rate	$1,246.45
Rate for Payer: Cash Price	$771.00
Rate for Payer: Hawaii Western Management Group Commercial	$899.50
Rate for Payer: Health Management Network Commercial	$1,092.25
Rate for Payer: Kaiser Permanente Commercial	$1,156.50
Rate for Payer: MDX Hawaii PPO	$1,246.45
Rate for Payer: University Health Alliance Commercial	$719.60

PLATE 3.5 5-HOLE/64MM 223.55

Facility

$1,285.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$642.50
Max. Negotiated Rate	$1,246.45
Rate for Payer: AlohaCare Medicaid	$642.50
Rate for Payer: AlohaCare Medicare	$976.60
Rate for Payer: Cash Price	$771.00
Rate for Payer: Devoted Health Medicare	$1,079.40
Rate for Payer: Hawaii Medical Service Association Medicare	$976.60
Rate for Payer: Hawaii Western Management Group Commercial	$899.50
Rate for Payer: Health Management Network Commercial	$1,092.25
Rate for Payer: Humana Medicare	$976.60
Rate for Payer: Kaiser Permanente Commercial	$1,156.50
Rate for Payer: Kaiser Permanente Medicaid	$655.35
Rate for Payer: Kaiser Permanente Medicare	$976.60
Rate for Payer: MDX Hawaii PPO	$1,246.45
Rate for Payer: Ohana Health Plan Medicaid	$976.60
Rate for Payer: Ohana Health Plan Medicare	$976.60
Rate for Payer: UnitedHealthcare Medicare	$976.60
Rate for Payer: University Health Alliance Commercial	$719.60

Know your out-of-pocket cost for care.

All Charges