Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE 9H MED LEFT P53-009-L001

Facility

$3,293.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,646.50
Max. Negotiated Rate	$3,194.21
Rate for Payer: AlohaCare Medicaid	$1,646.50
Rate for Payer: AlohaCare Medicare	$2,502.68
Rate for Payer: Cash Price	$1,975.80
Rate for Payer: Devoted Health Medicare	$2,766.12
Rate for Payer: Hawaii Medical Service Association Medicare	$2,502.68
Rate for Payer: Hawaii Western Management Group Commercial	$2,305.10
Rate for Payer: Health Management Network Commercial	$2,799.05
Rate for Payer: Humana Medicare	$2,502.68
Rate for Payer: Kaiser Permanente Commercial	$2,963.70
Rate for Payer: Kaiser Permanente Medicaid	$1,679.43
Rate for Payer: Kaiser Permanente Medicare	$2,502.68
Rate for Payer: MDX Hawaii PPO	$3,194.21
Rate for Payer: Ohana Health Plan Medicaid	$2,502.68
Rate for Payer: Ohana Health Plan Medicare	$2,502.68
Rate for Payer: UnitedHealthcare Medicare	$2,502.68
Rate for Payer: University Health Alliance Commercial	$1,844.08

PLATE 9H MED LEFT P53-009-L001

Facility

$3,293.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,844.08
Max. Negotiated Rate	$3,194.21
Rate for Payer: Cash Price	$1,975.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,305.10
Rate for Payer: Health Management Network Commercial	$2,799.05
Rate for Payer: Kaiser Permanente Commercial	$2,963.70
Rate for Payer: MDX Hawaii PPO	$3,194.21
Rate for Payer: University Health Alliance Commercial	$1,844.08

PLATE ANKLE FIX TI STANDARD LT

Facility

$3,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,128.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

PLATE ANKLE FIX TI STANDARD LT

Facility

$3,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$3,686.00
Rate for Payer: AlohaCare Medicaid	$1,900.00
Rate for Payer: AlohaCare Medicare	$2,888.00
Rate for Payer: Cash Price	$2,280.00
Rate for Payer: Devoted Health Medicare	$3,192.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,888.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,660.00
Rate for Payer: Health Management Network Commercial	$3,230.00
Rate for Payer: Humana Medicare	$2,888.00
Rate for Payer: Kaiser Permanente Commercial	$3,420.00
Rate for Payer: Kaiser Permanente Medicaid	$1,938.00
Rate for Payer: Kaiser Permanente Medicare	$2,888.00
Rate for Payer: MDX Hawaii PPO	$3,686.00
Rate for Payer: Ohana Health Plan Medicaid	$2,888.00
Rate for Payer: Ohana Health Plan Medicare	$2,888.00
Rate for Payer: UnitedHealthcare Medicare	$2,888.00
Rate for Payer: University Health Alliance Commercial	$2,128.00

PLATE ANKLE HOOK LT 4H HOOKL-4

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,710.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$1,890.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,710.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,710.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,710.00
Rate for Payer: Ohana Health Plan Medicare	$1,710.00
Rate for Payer: UnitedHealthcare Medicare	$1,710.00
Rate for Payer: University Health Alliance Commercial	$1,260.00

PLATE ANKLE HOOK LT 4H HOOKL-4

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,260.00

PLATE ANKLE HOOK RT 4H HOOKR-4

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,125.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: AlohaCare Medicaid	$1,125.00
Rate for Payer: AlohaCare Medicare	$1,710.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Devoted Health Medicare	$1,890.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,710.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Humana Medicare	$1,710.00
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: Kaiser Permanente Medicaid	$1,147.50
Rate for Payer: Kaiser Permanente Medicare	$1,710.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: Ohana Health Plan Medicaid	$1,710.00
Rate for Payer: Ohana Health Plan Medicare	$1,710.00
Rate for Payer: UnitedHealthcare Medicare	$1,710.00
Rate for Payer: University Health Alliance Commercial	$1,260.00

PLATE ANKLE HOOK RT 4H HOOKR-4

Facility

$2,250.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,260.00
Max. Negotiated Rate	$2,182.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,575.00
Rate for Payer: Health Management Network Commercial	$1,912.50
Rate for Payer: Kaiser Permanente Commercial	$2,025.00
Rate for Payer: MDX Hawaii PPO	$2,182.50
Rate for Payer: University Health Alliance Commercial	$1,260.00

PLATE ANKLE HOOK RT 6H HOOKR-6

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

PLATE ANKLE HOOK RT 6H HOOKR-6

Facility

$2,400.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: AlohaCare Medicaid	$1,200.00
Rate for Payer: AlohaCare Medicare	$1,824.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Devoted Health Medicare	$2,016.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,824.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Humana Medicare	$1,824.00
Rate for Payer: Kaiser Permanente Commercial	$2,160.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: Kaiser Permanente Medicare	$1,824.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: Ohana Health Plan Medicaid	$1,824.00
Rate for Payer: Ohana Health Plan Medicare	$1,824.00
Rate for Payer: UnitedHealthcare Medicare	$1,824.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

PLATE ANKLE HOOK RT 8H HOOKR-8

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$2,473.50
Rate for Payer: AlohaCare Medicaid	$1,275.00
Rate for Payer: AlohaCare Medicare	$1,938.00
Rate for Payer: Cash Price	$1,530.00
Rate for Payer: Devoted Health Medicare	$2,142.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,938.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,785.00
Rate for Payer: Health Management Network Commercial	$2,167.50
Rate for Payer: Humana Medicare	$1,938.00
Rate for Payer: Kaiser Permanente Commercial	$2,295.00
Rate for Payer: Kaiser Permanente Medicaid	$1,300.50
Rate for Payer: Kaiser Permanente Medicare	$1,938.00
Rate for Payer: MDX Hawaii PPO	$2,473.50
Rate for Payer: Ohana Health Plan Medicaid	$1,938.00
Rate for Payer: Ohana Health Plan Medicare	$1,938.00
Rate for Payer: UnitedHealthcare Medicare	$1,938.00
Rate for Payer: University Health Alliance Commercial	$1,428.00

PLATE ANKLE HOOK RT 8H HOOKR-8

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,428.00
Max. Negotiated Rate	$2,473.50
Rate for Payer: Cash Price	$1,530.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,785.00
Rate for Payer: Health Management Network Commercial	$2,167.50
Rate for Payer: Kaiser Permanente Commercial	$2,295.00
Rate for Payer: MDX Hawaii PPO	$2,473.50
Rate for Payer: University Health Alliance Commercial	$1,428.00

PLATE ANKLE TI LARGE 28.14.107

Facility

$4,700.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,350.00
Max. Negotiated Rate	$4,559.00
Rate for Payer: AlohaCare Medicaid	$2,350.00
Rate for Payer: AlohaCare Medicare	$3,572.00
Rate for Payer: Cash Price	$2,820.00
Rate for Payer: Devoted Health Medicare	$3,948.00
Rate for Payer: Hawaii Medical Service Association Medicare	$3,572.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,290.00
Rate for Payer: Health Management Network Commercial	$3,995.00
Rate for Payer: Humana Medicare	$3,572.00
Rate for Payer: Kaiser Permanente Commercial	$4,230.00
Rate for Payer: Kaiser Permanente Medicaid	$2,397.00
Rate for Payer: Kaiser Permanente Medicare	$3,572.00
Rate for Payer: MDX Hawaii PPO	$4,559.00
Rate for Payer: Ohana Health Plan Medicaid	$3,572.00
Rate for Payer: Ohana Health Plan Medicare	$3,572.00
Rate for Payer: UnitedHealthcare Medicare	$3,572.00
Rate for Payer: University Health Alliance Commercial	$2,632.00

PLATE ANKLE TI LARGE 28.14.107

Facility

$4,700.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,632.00
Max. Negotiated Rate	$4,559.00
Rate for Payer: Cash Price	$2,820.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,290.00
Rate for Payer: Health Management Network Commercial	$3,995.00
Rate for Payer: Kaiser Permanente Commercial	$4,230.00
Rate for Payer: MDX Hawaii PPO	$4,559.00
Rate for Payer: University Health Alliance Commercial	$2,632.00

PLATE BASE IJS-ELB-BPA

Facility

$11,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$5,689.00
Max. Negotiated Rate	$11,036.66
Rate for Payer: AlohaCare Medicaid	$5,689.00
Rate for Payer: AlohaCare Medicare	$8,647.28
Rate for Payer: Cash Price	$6,826.80
Rate for Payer: Devoted Health Medicare	$9,557.52
Rate for Payer: Hawaii Medical Service Association Medicare	$8,647.28
Rate for Payer: Hawaii Western Management Group Commercial	$7,964.60
Rate for Payer: Health Management Network Commercial	$9,671.30
Rate for Payer: Humana Medicare	$8,647.28
Rate for Payer: Kaiser Permanente Commercial	$10,240.20
Rate for Payer: Kaiser Permanente Medicaid	$5,802.78
Rate for Payer: Kaiser Permanente Medicare	$8,647.28
Rate for Payer: MDX Hawaii PPO	$11,036.66
Rate for Payer: Ohana Health Plan Medicaid	$8,647.28
Rate for Payer: Ohana Health Plan Medicare	$8,647.28
Rate for Payer: UnitedHealthcare Medicare	$8,647.28
Rate for Payer: University Health Alliance Commercial	$6,371.68

PLATE BASE IJS-ELB-BPA

Facility

$11,378.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$6,371.68
Max. Negotiated Rate	$11,036.66
Rate for Payer: Cash Price	$6,826.80
Rate for Payer: Hawaii Western Management Group Commercial	$7,964.60
Rate for Payer: Health Management Network Commercial	$9,671.30
Rate for Payer: Kaiser Permanente Commercial	$10,240.20
Rate for Payer: MDX Hawaii PPO	$11,036.66
Rate for Payer: University Health Alliance Commercial	$6,371.68

PLATE BNE LCK OLECRANON 629366

Facility

$3,151.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,575.50
Max. Negotiated Rate	$3,056.47
Rate for Payer: AlohaCare Medicaid	$1,575.50
Rate for Payer: AlohaCare Medicare	$2,394.76
Rate for Payer: Cash Price	$1,890.60
Rate for Payer: Devoted Health Medicare	$2,646.84
Rate for Payer: Hawaii Medical Service Association Medicare	$2,394.76
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.70
Rate for Payer: Health Management Network Commercial	$2,678.35
Rate for Payer: Humana Medicare	$2,394.76
Rate for Payer: Kaiser Permanente Commercial	$2,835.90
Rate for Payer: Kaiser Permanente Medicaid	$1,607.01
Rate for Payer: Kaiser Permanente Medicare	$2,394.76
Rate for Payer: MDX Hawaii PPO	$3,056.47
Rate for Payer: Ohana Health Plan Medicaid	$2,394.76
Rate for Payer: Ohana Health Plan Medicare	$2,394.76
Rate for Payer: UnitedHealthcare Medicare	$2,394.76
Rate for Payer: University Health Alliance Commercial	$1,764.56

PLATE BNE LCK OLECRANON 629366

Facility

$3,151.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,764.56
Max. Negotiated Rate	$3,056.47
Rate for Payer: Cash Price	$1,890.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,205.70
Rate for Payer: Health Management Network Commercial	$2,678.35
Rate for Payer: Kaiser Permanente Commercial	$2,835.90
Rate for Payer: MDX Hawaii PPO	$3,056.47
Rate for Payer: University Health Alliance Commercial	$1,764.56

PLATE BNE LCK OLECRANON 629626

Facility

$2,509.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,254.50
Max. Negotiated Rate	$2,433.73
Rate for Payer: AlohaCare Medicaid	$1,254.50
Rate for Payer: AlohaCare Medicare	$1,906.84
Rate for Payer: Cash Price	$1,505.40
Rate for Payer: Devoted Health Medicare	$2,107.56
Rate for Payer: Hawaii Medical Service Association Medicare	$1,906.84
Rate for Payer: Hawaii Western Management Group Commercial	$1,756.30
Rate for Payer: Health Management Network Commercial	$2,132.65
Rate for Payer: Humana Medicare	$1,906.84
Rate for Payer: Kaiser Permanente Commercial	$2,258.10
Rate for Payer: Kaiser Permanente Medicaid	$1,279.59
Rate for Payer: Kaiser Permanente Medicare	$1,906.84
Rate for Payer: MDX Hawaii PPO	$2,433.73
Rate for Payer: Ohana Health Plan Medicaid	$1,906.84
Rate for Payer: Ohana Health Plan Medicare	$1,906.84
Rate for Payer: UnitedHealthcare Medicare	$1,906.84
Rate for Payer: University Health Alliance Commercial	$1,405.04

PLATE BNE LCK OLECRANON 629626

Facility

$2,509.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,405.04
Max. Negotiated Rate	$2,433.73
Rate for Payer: Cash Price	$1,505.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,756.30
Rate for Payer: Health Management Network Commercial	$2,132.65
Rate for Payer: Kaiser Permanente Commercial	$2,258.10
Rate for Payer: MDX Hawaii PPO	$2,433.73
Rate for Payer: University Health Alliance Commercial	$1,405.04

PLATE BONE 16H 336M 02.124.416

Facility

$4,808.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,404.00
Max. Negotiated Rate	$4,663.76
Rate for Payer: AlohaCare Medicaid	$2,404.00
Rate for Payer: AlohaCare Medicare	$3,654.08
Rate for Payer: Cash Price	$2,884.80
Rate for Payer: Devoted Health Medicare	$4,038.72
Rate for Payer: Hawaii Medical Service Association Medicare	$3,654.08
Rate for Payer: Hawaii Western Management Group Commercial	$3,365.60
Rate for Payer: Health Management Network Commercial	$4,086.80
Rate for Payer: Humana Medicare	$3,654.08
Rate for Payer: Kaiser Permanente Commercial	$4,327.20
Rate for Payer: Kaiser Permanente Medicaid	$2,452.08
Rate for Payer: Kaiser Permanente Medicare	$3,654.08
Rate for Payer: MDX Hawaii PPO	$4,663.76
Rate for Payer: Ohana Health Plan Medicaid	$3,654.08
Rate for Payer: Ohana Health Plan Medicare	$3,654.08
Rate for Payer: UnitedHealthcare Medicare	$3,654.08
Rate for Payer: University Health Alliance Commercial	$2,692.48

PLATE BONE 16H 336M 02.124.416

Facility

$4,808.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,692.48
Max. Negotiated Rate	$4,663.76
Rate for Payer: Cash Price	$2,884.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,365.60
Rate for Payer: Health Management Network Commercial	$4,086.80
Rate for Payer: Kaiser Permanente Commercial	$4,327.20
Rate for Payer: MDX Hawaii PPO	$4,663.76
Rate for Payer: University Health Alliance Commercial	$2,692.48

PLATE BONE 2X10 HOLE 629783

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 BONE 2X10 HOLE 629783

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 BONE 5 X 10 HOLE T-PLATE

Facility

$2,437.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,364.72
Max. Negotiated Rate	$2,363.89
Rate for Payer: Cash Price	$1,462.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,705.90
Rate for Payer: Health Management Network Commercial	$2,071.45
Rate for Payer: Kaiser Permanente Commercial	$2,193.30
Rate for Payer: MDX Hawaii PPO	$2,363.89
Rate for Payer: University Health Alliance Commercial	$1,364.72

Know your out-of-pocket cost for care.

All Charges