Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE 3.5MM 7-HOLE/82MM 245.17

Facility

$1,043.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$584.08
Max. Negotiated Rate	$1,011.71
Rate for Payer: Cash Price	$625.80
Rate for Payer: Hawaii Western Management Group Commercial	$730.10
Rate for Payer: Health Management Network Commercial	$886.55
Rate for Payer: Kaiser Permanente Commercial	$938.70
Rate for Payer: MDX Hawaii PPO	$1,011.71
Rate for Payer: University Health Alliance Commercial	$584.08

PLATE 3.5MM 7HOLE/85MM 248.07

Facility

$626.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$350.56
Max. Negotiated Rate	$607.22
Rate for Payer: Cash Price	$375.60
Rate for Payer: Hawaii Western Management Group Commercial	$438.20
Rate for Payer: Health Management Network Commercial	$532.10
Rate for Payer: Kaiser Permanente Commercial	$563.40
Rate for Payer: MDX Hawaii PPO	$607.22
Rate for Payer: University Health Alliance Commercial	$350.56

PLATE 3.5MM 7HOLE/85MM 248.07

Facility

$626.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$313.00
Max. Negotiated Rate	$607.22
Rate for Payer: AlohaCare Medicaid	$313.00
Rate for Payer: AlohaCare Medicare	$475.76
Rate for Payer: Cash Price	$375.60
Rate for Payer: Devoted Health Medicare	$525.84
Rate for Payer: Hawaii Medical Service Association Medicare	$475.76
Rate for Payer: Hawaii Western Management Group Commercial	$438.20
Rate for Payer: Health Management Network Commercial	$532.10
Rate for Payer: Humana Medicare	$475.76
Rate for Payer: Kaiser Permanente Commercial	$563.40
Rate for Payer: Kaiser Permanente Medicaid	$319.26
Rate for Payer: Kaiser Permanente Medicare	$475.76
Rate for Payer: MDX Hawaii PPO	$607.22
Rate for Payer: Ohana Health Plan Medicaid	$475.76
Rate for Payer: Ohana Health Plan Medicare	$475.76
Rate for Payer: UnitedHealthcare Medicare	$475.76
Rate for Payer: University Health Alliance Commercial	$350.56

PLATE 3.5MM 8-HOLE/94MM 245.18

Facility

$1,043.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$521.50
Max. Negotiated Rate	$1,011.71
Rate for Payer: AlohaCare Medicaid	$521.50
Rate for Payer: AlohaCare Medicare	$792.68
Rate for Payer: Cash Price	$625.80
Rate for Payer: Devoted Health Medicare	$876.12
Rate for Payer: Hawaii Medical Service Association Medicare	$792.68
Rate for Payer: Hawaii Western Management Group Commercial	$730.10
Rate for Payer: Health Management Network Commercial	$886.55
Rate for Payer: Humana Medicare	$792.68
Rate for Payer: Kaiser Permanente Commercial	$938.70
Rate for Payer: Kaiser Permanente Medicaid	$531.93
Rate for Payer: Kaiser Permanente Medicare	$792.68
Rate for Payer: MDX Hawaii PPO	$1,011.71
Rate for Payer: Ohana Health Plan Medicaid	$792.68
Rate for Payer: Ohana Health Plan Medicare	$792.68
Rate for Payer: UnitedHealthcare Medicare	$792.68
Rate for Payer: University Health Alliance Commercial	$584.08

PLATE 3.5MM 8-HOLE/94MM 245.18

Facility

$1,043.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$584.08
Max. Negotiated Rate	$1,011.71
Rate for Payer: Cash Price	$625.80
Rate for Payer: Hawaii Western Management Group Commercial	$730.10
Rate for Payer: Health Management Network Commercial	$886.55
Rate for Payer: Kaiser Permanente Commercial	$938.70
Rate for Payer: MDX Hawaii PPO	$1,011.71
Rate for Payer: University Health Alliance Commercial	$584.08

PLATE 3.5MM 8HOLE/97MM 248.08

Facility

$626.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$313.00
Max. Negotiated Rate	$607.22
Rate for Payer: AlohaCare Medicaid	$313.00
Rate for Payer: AlohaCare Medicare	$475.76
Rate for Payer: Cash Price	$375.60
Rate for Payer: Devoted Health Medicare	$525.84
Rate for Payer: Hawaii Medical Service Association Medicare	$475.76
Rate for Payer: Hawaii Western Management Group Commercial	$438.20
Rate for Payer: Health Management Network Commercial	$532.10
Rate for Payer: Humana Medicare	$475.76
Rate for Payer: Kaiser Permanente Commercial	$563.40
Rate for Payer: Kaiser Permanente Medicaid	$319.26
Rate for Payer: Kaiser Permanente Medicare	$475.76
Rate for Payer: MDX Hawaii PPO	$607.22
Rate for Payer: Ohana Health Plan Medicaid	$475.76
Rate for Payer: Ohana Health Plan Medicare	$475.76
Rate for Payer: UnitedHealthcare Medicare	$475.76
Rate for Payer: University Health Alliance Commercial	$350.56

PLATE 3.5MM 8HOLE/97MM 248.08

Facility

$626.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$350.56
Max. Negotiated Rate	$607.22
Rate for Payer: Cash Price	$375.60
Rate for Payer: Hawaii Western Management Group Commercial	$438.20
Rate for Payer: Health Management Network Commercial	$532.10
Rate for Payer: Kaiser Permanente Commercial	$563.40
Rate for Payer: MDX Hawaii PPO	$607.22
Rate for Payer: University Health Alliance Commercial	$350.56

PLATE 3.5MM 9HOLE/106MM 245.19

Facility

$1,043.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$521.50
Max. Negotiated Rate	$1,011.71
Rate for Payer: AlohaCare Medicaid	$521.50
Rate for Payer: AlohaCare Medicare	$792.68
Rate for Payer: Cash Price	$625.80
Rate for Payer: Devoted Health Medicare	$876.12
Rate for Payer: Hawaii Medical Service Association Medicare	$792.68
Rate for Payer: Hawaii Western Management Group Commercial	$730.10
Rate for Payer: Health Management Network Commercial	$886.55
Rate for Payer: Humana Medicare	$792.68
Rate for Payer: Kaiser Permanente Commercial	$938.70
Rate for Payer: Kaiser Permanente Medicaid	$531.93
Rate for Payer: Kaiser Permanente Medicare	$792.68
Rate for Payer: MDX Hawaii PPO	$1,011.71
Rate for Payer: Ohana Health Plan Medicaid	$792.68
Rate for Payer: Ohana Health Plan Medicare	$792.68
Rate for Payer: UnitedHealthcare Medicare	$792.68
Rate for Payer: University Health Alliance Commercial	$584.08

PLATE 3.5MM 9HOLE/106MM 245.19

Facility

$1,043.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$584.08
Max. Negotiated Rate	$1,011.71
Rate for Payer: Cash Price	$625.80
Rate for Payer: Hawaii Western Management Group Commercial	$730.10
Rate for Payer: Health Management Network Commercial	$886.55
Rate for Payer: Kaiser Permanente Commercial	$938.70
Rate for Payer: MDX Hawaii PPO	$1,011.71
Rate for Payer: University Health Alliance Commercial	$584.08

PLATE 3.5MM LAPIDUS 336-3560

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,697.36
Max. Negotiated Rate	$2,940.07
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: Kaiser Permanente Commercial	$2,727.90
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 3.5MM LAPIDUS 336-3560

Facility

$3,031.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,515.50
Max. Negotiated Rate	$2,940.07
Rate for Payer: AlohaCare Medicaid	$1,515.50
Rate for Payer: AlohaCare Medicare	$2,303.56
Rate for Payer: Cash Price	$1,818.60
Rate for Payer: Devoted Health Medicare	$2,546.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,303.56
Rate for Payer: Hawaii Western Management Group Commercial	$2,121.70
Rate for Payer: Health Management Network Commercial	$2,576.35
Rate for Payer: Humana Medicare	$2,303.56
Rate for Payer: Kaiser Permanente Commercial	$2,727.90
Rate for Payer: Kaiser Permanente Medicaid	$1,545.81
Rate for Payer: Kaiser Permanente Medicare	$2,303.56
Rate for Payer: MDX Hawaii PPO	$2,940.07
Rate for Payer: Ohana Health Plan Medicaid	$2,303.56
Rate for Payer: Ohana Health Plan Medicare	$2,303.56
Rate for Payer: UnitedHealthcare Medicare	$2,303.56
Rate for Payer: University Health Alliance Commercial	$1,697.36

PLATE 3.5 TIBIA RT 02.127.210

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,832.00
Max. Negotiated Rate	$3,554.08
Rate for Payer: AlohaCare Medicaid	$1,832.00
Rate for Payer: AlohaCare Medicare	$2,784.64
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Devoted Health Medicare	$3,077.76
Rate for Payer: Hawaii Medical Service Association Medicare	$2,784.64
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Humana Medicare	$2,784.64
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: Kaiser Permanente Medicaid	$1,868.64
Rate for Payer: Kaiser Permanente Medicare	$2,784.64
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: Ohana Health Plan Medicaid	$2,784.64
Rate for Payer: Ohana Health Plan Medicare	$2,784.64
Rate for Payer: UnitedHealthcare Medicare	$2,784.64
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE 3.5 TIBIA RT 02.127.210

Facility

$3,664.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,051.84
Max. Negotiated Rate	$3,554.08
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,564.80
Rate for Payer: Health Management Network Commercial	$3,114.40
Rate for Payer: Kaiser Permanente Commercial	$3,297.60
Rate for Payer: MDX Hawaii PPO	$3,554.08
Rate for Payer: University Health Alliance Commercial	$2,051.84

PLATE 3.5X158 6H/RT 02.104.006

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,625.00
Max. Negotiated Rate	$3,152.50
Rate for Payer: AlohaCare Medicaid	$1,625.00
Rate for Payer: AlohaCare Medicare	$2,470.00
Rate for Payer: Cash Price	$1,950.00
Rate for Payer: Devoted Health Medicare	$2,730.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,470.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,275.00
Rate for Payer: Health Management Network Commercial	$2,762.50
Rate for Payer: Humana Medicare	$2,470.00
Rate for Payer: Kaiser Permanente Commercial	$2,925.00
Rate for Payer: Kaiser Permanente Medicaid	$1,657.50
Rate for Payer: Kaiser Permanente Medicare	$2,470.00
Rate for Payer: MDX Hawaii PPO	$3,152.50
Rate for Payer: Ohana Health Plan Medicaid	$2,470.00
Rate for Payer: Ohana Health Plan Medicare	$2,470.00
Rate for Payer: UnitedHealthcare Medicare	$2,470.00
Rate for Payer: University Health Alliance Commercial	$1,820.00

PLATE 3.5X158 6H/RT 02.104.006

Facility

$3,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,820.00
Max. Negotiated Rate	$3,152.50
Rate for Payer: Cash Price	$1,950.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,275.00
Rate for Payer: Health Management Network Commercial	$2,762.50
Rate for Payer: Kaiser Permanente Commercial	$2,925.00
Rate for Payer: MDX Hawaii PPO	$3,152.50
Rate for Payer: University Health Alliance Commercial	$1,820.00

PLATE 3.5X86MM 2HOLE 236.503

Facility

$2,073.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,160.88
Max. Negotiated Rate	$2,010.81
Rate for Payer: Cash Price	$1,243.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.10
Rate for Payer: Health Management Network Commercial	$1,762.05
Rate for Payer: Kaiser Permanente Commercial	$1,865.70
Rate for Payer: MDX Hawaii PPO	$2,010.81
Rate for Payer: University Health Alliance Commercial	$1,160.88

PLATE 3.5X86MM 2HOLE 236.503

Facility

$2,073.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,036.50
Max. Negotiated Rate	$2,010.81
Rate for Payer: AlohaCare Medicaid	$1,036.50
Rate for Payer: AlohaCare Medicare	$1,575.48
Rate for Payer: Cash Price	$1,243.80
Rate for Payer: Devoted Health Medicare	$1,741.32
Rate for Payer: Hawaii Medical Service Association Medicare	$1,575.48
Rate for Payer: Hawaii Western Management Group Commercial	$1,451.10
Rate for Payer: Health Management Network Commercial	$1,762.05
Rate for Payer: Humana Medicare	$1,575.48
Rate for Payer: Kaiser Permanente Commercial	$1,865.70
Rate for Payer: Kaiser Permanente Medicaid	$1,057.23
Rate for Payer: Kaiser Permanente Medicare	$1,575.48
Rate for Payer: MDX Hawaii PPO	$2,010.81
Rate for Payer: Ohana Health Plan Medicaid	$1,575.48
Rate for Payer: Ohana Health Plan Medicare	$1,575.48
Rate for Payer: UnitedHealthcare Medicare	$1,575.48
Rate for Payer: University Health Alliance Commercial	$1,160.88

PLATE 3 HOLE 629363

Facility

$2,858.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.48
Max. Negotiated Rate	$2,772.26
Rate for Payer: Cash Price	$1,714.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,000.60
Rate for Payer: Health Management Network Commercial	$2,429.30
Rate for Payer: Kaiser Permanente Commercial	$2,572.20
Rate for Payer: MDX Hawaii PPO	$2,772.26
Rate for Payer: University Health Alliance Commercial	$1,600.48

PLATE 3 HOLE 629363

Facility

$2,858.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,429.00
Max. Negotiated Rate	$2,772.26
Rate for Payer: AlohaCare Medicaid	$1,429.00
Rate for Payer: AlohaCare Medicare	$2,172.08
Rate for Payer: Cash Price	$1,714.80
Rate for Payer: Devoted Health Medicare	$2,400.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,172.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,000.60
Rate for Payer: Health Management Network Commercial	$2,429.30
Rate for Payer: Humana Medicare	$2,172.08
Rate for Payer: Kaiser Permanente Commercial	$2,572.20
Rate for Payer: Kaiser Permanente Medicaid	$1,457.58
Rate for Payer: Kaiser Permanente Medicare	$2,172.08
Rate for Payer: MDX Hawaii PPO	$2,772.26
Rate for Payer: Ohana Health Plan Medicaid	$2,172.08
Rate for Payer: Ohana Health Plan Medicare	$2,172.08
Rate for Payer: UnitedHealthcare Medicare	$2,172.08
Rate for Payer: University Health Alliance Commercial	$1,600.48

PLATE 3 HOLE 7 PEG VLBPR-3-7N

Facility

$3,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,691.20
Max. Negotiated Rate	$2,929.40
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,114.00
Rate for Payer: Health Management Network Commercial	$2,567.00
Rate for Payer: Kaiser Permanente Commercial	$2,718.00
Rate for Payer: MDX Hawaii PPO	$2,929.40
Rate for Payer: University Health Alliance Commercial	$1,691.20

PLATE 3 HOLE 7 PEG VLBPR-3-7N

Facility

$3,020.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,510.00
Max. Negotiated Rate	$2,929.40
Rate for Payer: AlohaCare Medicaid	$1,510.00
Rate for Payer: AlohaCare Medicare	$2,295.20
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Devoted Health Medicare	$2,536.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,295.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,114.00
Rate for Payer: Health Management Network Commercial	$2,567.00
Rate for Payer: Humana Medicare	$2,295.20
Rate for Payer: Kaiser Permanente Commercial	$2,718.00
Rate for Payer: Kaiser Permanente Medicaid	$1,540.20
Rate for Payer: Kaiser Permanente Medicare	$2,295.20
Rate for Payer: MDX Hawaii PPO	$2,929.40
Rate for Payer: Ohana Health Plan Medicaid	$2,295.20
Rate for Payer: Ohana Health Plan Medicare	$2,295.20
Rate for Payer: UnitedHealthcare Medicare	$2,295.20
Rate for Payer: University Health Alliance Commercial	$1,691.20

PLATE 3-HOLE/88MM 240.23

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$457.00
Max. Negotiated Rate	$886.58
Rate for Payer: AlohaCare Medicaid	$457.00
Rate for Payer: AlohaCare Medicare	$694.64
Rate for Payer: Cash Price	$548.40
Rate for Payer: Devoted Health Medicare	$767.76
Rate for Payer: Hawaii Medical Service Association Medicare	$694.64
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Humana Medicare	$694.64
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: Kaiser Permanente Medicaid	$466.14
Rate for Payer: Kaiser Permanente Medicare	$694.64
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: Ohana Health Plan Medicaid	$694.64
Rate for Payer: Ohana Health Plan Medicare	$694.64
Rate for Payer: UnitedHealthcare Medicare	$694.64
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE 3-HOLE/88MM 240.23

Facility

$914.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$511.84
Max. Negotiated Rate	$886.58
Rate for Payer: Cash Price	$548.40
Rate for Payer: Hawaii Western Management Group Commercial	$639.80
Rate for Payer: Health Management Network Commercial	$776.90
Rate for Payer: Kaiser Permanente Commercial	$822.60
Rate for Payer: MDX Hawaii PPO	$886.58
Rate for Payer: University Health Alliance Commercial	$511.84

PLATE 3 HOLES 84MM

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,228.08
Max. Negotiated Rate	$2,127.21
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Kaiser Permanente Commercial	$1,973.70
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: University Health Alliance Commercial	$1,228.08

PLATE 3 HOLES 84MM

Facility

$2,193.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,096.50
Max. Negotiated Rate	$2,127.21
Rate for Payer: AlohaCare Medicaid	$1,096.50
Rate for Payer: AlohaCare Medicare	$1,666.68
Rate for Payer: Cash Price	$1,315.80
Rate for Payer: Devoted Health Medicare	$1,842.12
Rate for Payer: Hawaii Medical Service Association Medicare	$1,666.68
Rate for Payer: Hawaii Western Management Group Commercial	$1,535.10
Rate for Payer: Health Management Network Commercial	$1,864.05
Rate for Payer: Humana Medicare	$1,666.68
Rate for Payer: Kaiser Permanente Commercial	$1,973.70
Rate for Payer: Kaiser Permanente Medicaid	$1,118.43
Rate for Payer: Kaiser Permanente Medicare	$1,666.68
Rate for Payer: MDX Hawaii PPO	$2,127.21
Rate for Payer: Ohana Health Plan Medicaid	$1,666.68
Rate for Payer: Ohana Health Plan Medicare	$1,666.68
Rate for Payer: UnitedHealthcare Medicare	$1,666.68
Rate for Payer: University Health Alliance Commercial	$1,228.08

Know your out-of-pocket cost for care.

All Charges