Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE BONE 5 X 10 HOLE T-PLATE

Facility

$2,437.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,218.50
Max. Negotiated Rate	$2,363.89
Rate for Payer: AlohaCare Medicaid	$1,218.50
Rate for Payer: AlohaCare Medicare	$1,852.12
Rate for Payer: Cash Price	$1,462.20
Rate for Payer: Devoted Health Medicare	$2,047.08
Rate for Payer: Hawaii Medical Service Association Medicare	$1,852.12
Rate for Payer: Hawaii Western Management Group Commercial	$1,705.90
Rate for Payer: Health Management Network Commercial	$2,071.45
Rate for Payer: Humana Medicare	$1,852.12
Rate for Payer: Kaiser Permanente Commercial	$2,193.30
Rate for Payer: Kaiser Permanente Medicaid	$1,242.87
Rate for Payer: Kaiser Permanente Medicare	$1,852.12
Rate for Payer: MDX Hawaii PPO	$2,363.89
Rate for Payer: Ohana Health Plan Medicaid	$1,852.12
Rate for Payer: Ohana Health Plan Medicare	$1,852.12
Rate for Payer: UnitedHealthcare Medicare	$1,852.12
Rate for Payer: University Health Alliance Commercial	$1,364.72

PLATE BONE FEM LF 02.124.411

Facility

$4,329.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,164.50
Max. Negotiated Rate	$4,199.13
Rate for Payer: AlohaCare Medicaid	$2,164.50
Rate for Payer: AlohaCare Medicare	$3,290.04
Rate for Payer: Cash Price	$2,597.40
Rate for Payer: Devoted Health Medicare	$3,636.36
Rate for Payer: Hawaii Medical Service Association Medicare	$3,290.04
Rate for Payer: Hawaii Western Management Group Commercial	$3,030.30
Rate for Payer: Health Management Network Commercial	$3,679.65
Rate for Payer: Humana Medicare	$3,290.04
Rate for Payer: Kaiser Permanente Commercial	$3,896.10
Rate for Payer: Kaiser Permanente Medicaid	$2,207.79
Rate for Payer: Kaiser Permanente Medicare	$3,290.04
Rate for Payer: MDX Hawaii PPO	$4,199.13
Rate for Payer: Ohana Health Plan Medicaid	$3,290.04
Rate for Payer: Ohana Health Plan Medicare	$3,290.04
Rate for Payer: UnitedHealthcare Medicare	$3,290.04
Rate for Payer: University Health Alliance Commercial	$2,424.24

PLATE BONE FEM LF 02.124.411

Facility

$4,329.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,424.24
Max. Negotiated Rate	$4,199.13
Rate for Payer: Cash Price	$2,597.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,030.30
Rate for Payer: Health Management Network Commercial	$3,679.65
Rate for Payer: Kaiser Permanente Commercial	$3,896.10
Rate for Payer: MDX Hawaii PPO	$4,199.13
Rate for Payer: University Health Alliance Commercial	$2,424.24

PLATE BONE LCK 02.112.108

Facility

$2,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,291.36
Max. Negotiated Rate	$2,236.82
Rate for Payer: Cash Price	$1,383.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,614.20
Rate for Payer: Health Management Network Commercial	$1,960.10
Rate for Payer: Kaiser Permanente Commercial	$2,075.40
Rate for Payer: MDX Hawaii PPO	$2,236.82
Rate for Payer: University Health Alliance Commercial	$1,291.36

PLATE BONE LCK 02.112.108

Facility

$2,306.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,153.00
Max. Negotiated Rate	$2,236.82
Rate for Payer: AlohaCare Medicaid	$1,153.00
Rate for Payer: AlohaCare Medicare	$1,752.56
Rate for Payer: Cash Price	$1,383.60
Rate for Payer: Devoted Health Medicare	$1,937.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,752.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,614.20
Rate for Payer: Health Management Network Commercial	$1,960.10
Rate for Payer: Humana Medicare	$1,752.56
Rate for Payer: Kaiser Permanente Commercial	$2,075.40
Rate for Payer: Kaiser Permanente Medicaid	$1,176.06
Rate for Payer: Kaiser Permanente Medicare	$1,752.56
Rate for Payer: MDX Hawaii PPO	$2,236.82
Rate for Payer: Ohana Health Plan Medicaid	$1,752.56
Rate for Payer: Ohana Health Plan Medicare	$1,752.56
Rate for Payer: UnitedHealthcare Medicare	$1,752.56
Rate for Payer: University Health Alliance Commercial	$1,291.36

PLATE BONE LCK 7H 02.117.004

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 BONE LCK 7H 02.117.004

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 BONE LCK COMP CRV 629559

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,112.50
Max. Negotiated Rate	$2,158.25
Rate for Payer: AlohaCare Medicaid	$1,112.50
Rate for Payer: AlohaCare Medicare	$1,691.00
Rate for Payer: Cash Price	$1,335.00
Rate for Payer: Devoted Health Medicare	$1,869.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,691.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,557.50
Rate for Payer: Health Management Network Commercial	$1,891.25
Rate for Payer: Humana Medicare	$1,691.00
Rate for Payer: Kaiser Permanente Commercial	$2,002.50
Rate for Payer: Kaiser Permanente Medicaid	$1,134.75
Rate for Payer: Kaiser Permanente Medicare	$1,691.00
Rate for Payer: MDX Hawaii PPO	$2,158.25
Rate for Payer: Ohana Health Plan Medicaid	$1,691.00
Rate for Payer: Ohana Health Plan Medicare	$1,691.00
Rate for Payer: UnitedHealthcare Medicare	$1,691.00
Rate for Payer: University Health Alliance Commercial	$1,246.00

PLATE BONE LCK COMP CRV 629559

Facility

$2,225.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,246.00
Max. Negotiated Rate	$2,158.25
Rate for Payer: Cash Price	$1,335.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,557.50
Rate for Payer: Health Management Network Commercial	$1,891.25
Rate for Payer: Kaiser Permanente Commercial	$2,002.50
Rate for Payer: MDX Hawaii PPO	$2,158.25
Rate for Payer: University Health Alliance Commercial	$1,246.00

PLATE BONE LCK LF 02.117.504

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,539.44
Max. Negotiated Rate	$2,666.53
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE BONE LCK LF 02.117.504

Facility

$2,749.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,374.50
Max. Negotiated Rate	$2,666.53
Rate for Payer: AlohaCare Medicaid	$1,374.50
Rate for Payer: AlohaCare Medicare	$2,089.24
Rate for Payer: Cash Price	$1,649.40
Rate for Payer: Devoted Health Medicare	$2,309.16
Rate for Payer: Hawaii Medical Service Association Medicare	$2,089.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,924.30
Rate for Payer: Health Management Network Commercial	$2,336.65
Rate for Payer: Humana Medicare	$2,089.24
Rate for Payer: Kaiser Permanente Commercial	$2,474.10
Rate for Payer: Kaiser Permanente Medicaid	$1,401.99
Rate for Payer: Kaiser Permanente Medicare	$2,089.24
Rate for Payer: MDX Hawaii PPO	$2,666.53
Rate for Payer: Ohana Health Plan Medicaid	$2,089.24
Rate for Payer: Ohana Health Plan Medicare	$2,089.24
Rate for Payer: UnitedHealthcare Medicare	$2,089.24
Rate for Payer: University Health Alliance Commercial	$1,539.44

PLATE BONE LCK RT 02.117.606

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 BONE LCK RT 02.117.606

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 BONE LCK T-SHP 247.351

Facility

$1,627.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$911.12
Max. Negotiated Rate	$1,578.19
Rate for Payer: Cash Price	$976.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,138.90
Rate for Payer: Health Management Network Commercial	$1,382.95
Rate for Payer: Kaiser Permanente Commercial	$1,464.30
Rate for Payer: MDX Hawaii PPO	$1,578.19
Rate for Payer: University Health Alliance Commercial	$911.12

PLATE BONE LCK T-SHP 247.351

Facility

$1,627.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$813.50
Max. Negotiated Rate	$1,578.19
Rate for Payer: AlohaCare Medicaid	$813.50
Rate for Payer: AlohaCare Medicare	$1,236.52
Rate for Payer: Cash Price	$976.20
Rate for Payer: Devoted Health Medicare	$1,366.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,236.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,138.90
Rate for Payer: Health Management Network Commercial	$1,382.95
Rate for Payer: Humana Medicare	$1,236.52
Rate for Payer: Kaiser Permanente Commercial	$1,464.30
Rate for Payer: Kaiser Permanente Medicaid	$829.77
Rate for Payer: Kaiser Permanente Medicare	$1,236.52
Rate for Payer: MDX Hawaii PPO	$1,578.19
Rate for Payer: Ohana Health Plan Medicaid	$1,236.52
Rate for Payer: Ohana Health Plan Medicare	$1,236.52
Rate for Payer: UnitedHealthcare Medicare	$1,236.52
Rate for Payer: University Health Alliance Commercial	$911.12

PLATE BONE UNI 7HOLE 482.823

Facility

$1,611.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$902.16
Max. Negotiated Rate	$1,562.67
Rate for Payer: Cash Price	$966.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.70
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: University Health Alliance Commercial	$902.16

PLATE BONE UNI 7HOLE 482.823

Facility

$1,611.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$805.50
Max. Negotiated Rate	$1,562.67
Rate for Payer: AlohaCare Medicaid	$805.50
Rate for Payer: AlohaCare Medicare	$1,224.36
Rate for Payer: Cash Price	$966.60
Rate for Payer: Devoted Health Medicare	$1,353.24
Rate for Payer: Hawaii Medical Service Association Medicare	$1,224.36
Rate for Payer: Hawaii Western Management Group Commercial	$1,127.70
Rate for Payer: Health Management Network Commercial	$1,369.35
Rate for Payer: Humana Medicare	$1,224.36
Rate for Payer: Kaiser Permanente Commercial	$1,449.90
Rate for Payer: Kaiser Permanente Medicaid	$821.61
Rate for Payer: Kaiser Permanente Medicare	$1,224.36
Rate for Payer: MDX Hawaii PPO	$1,562.67
Rate for Payer: Ohana Health Plan Medicaid	$1,224.36
Rate for Payer: Ohana Health Plan Medicare	$1,224.36
Rate for Payer: UnitedHealthcare Medicare	$1,224.36
Rate for Payer: University Health Alliance Commercial	$902.16

PLATE BROAD 8H 629748

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 BROAD 8H 629748

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 BUTT-L RT 4H 86MM 240.54

Facility

$1,506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$843.36
Max. Negotiated Rate	$1,460.82
Rate for Payer: Cash Price	$903.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.20
Rate for Payer: Health Management Network Commercial	$1,280.10
Rate for Payer: Kaiser Permanente Commercial	$1,355.40
Rate for Payer: MDX Hawaii PPO	$1,460.82
Rate for Payer: University Health Alliance Commercial	$843.36

PLATE BUTT-L RT 4H 86MM 240.54

Facility

$1,506.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$753.00
Max. Negotiated Rate	$1,460.82
Rate for Payer: AlohaCare Medicaid	$753.00
Rate for Payer: AlohaCare Medicare	$1,144.56
Rate for Payer: Cash Price	$903.60
Rate for Payer: Devoted Health Medicare	$1,265.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,144.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,054.20
Rate for Payer: Health Management Network Commercial	$1,280.10
Rate for Payer: Humana Medicare	$1,144.56
Rate for Payer: Kaiser Permanente Commercial	$1,355.40
Rate for Payer: Kaiser Permanente Medicaid	$768.06
Rate for Payer: Kaiser Permanente Medicare	$1,144.56
Rate for Payer: MDX Hawaii PPO	$1,460.82
Rate for Payer: Ohana Health Plan Medicaid	$1,144.56
Rate for Payer: Ohana Health Plan Medicare	$1,144.56
Rate for Payer: UnitedHealthcare Medicare	$1,144.56
Rate for Payer: University Health Alliance Commercial	$843.36

PLATE BUTTRESS AR-8959TDS

Facility

$13,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$7,458.08
Max. Negotiated Rate	$12,918.46
Rate for Payer: Cash Price	$7,990.80
Rate for Payer: Hawaii Western Management Group Commercial	$9,322.60
Rate for Payer: Health Management Network Commercial	$11,320.30
Rate for Payer: Kaiser Permanente Commercial	$11,986.20
Rate for Payer: MDX Hawaii PPO	$12,918.46
Rate for Payer: University Health Alliance Commercial	$7,458.08

PLATE BUTTRESS AR-8959TDS

Facility

$13,318.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$6,659.00
Max. Negotiated Rate	$12,918.46
Rate for Payer: AlohaCare Medicaid	$6,659.00
Rate for Payer: AlohaCare Medicare	$10,121.68
Rate for Payer: Cash Price	$7,990.80
Rate for Payer: Devoted Health Medicare	$11,187.12
Rate for Payer: Hawaii Medical Service Association Medicare	$10,121.68
Rate for Payer: Hawaii Western Management Group Commercial	$9,322.60
Rate for Payer: Health Management Network Commercial	$11,320.30
Rate for Payer: Humana Medicare	$10,121.68
Rate for Payer: Kaiser Permanente Commercial	$11,986.20
Rate for Payer: Kaiser Permanente Medicaid	$6,792.18
Rate for Payer: Kaiser Permanente Medicare	$10,121.68
Rate for Payer: MDX Hawaii PPO	$12,918.46
Rate for Payer: Ohana Health Plan Medicaid	$10,121.68
Rate for Payer: Ohana Health Plan Medicare	$10,121.68
Rate for Payer: UnitedHealthcare Medicare	$10,121.68
Rate for Payer: University Health Alliance Commercial	$7,458.08

PLATE BUTTRES-T 4H 80MM 240.34

Facility

$2,094.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,172.64
Max. Negotiated Rate	$2,031.18
Rate for Payer: Cash Price	$1,256.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,465.80
Rate for Payer: Health Management Network Commercial	$1,779.90
Rate for Payer: Kaiser Permanente Commercial	$1,884.60
Rate for Payer: MDX Hawaii PPO	$2,031.18
Rate for Payer: University Health Alliance Commercial	$1,172.64

PLATE BUTTRES-T 4H 80MM 240.34

Facility

$2,094.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,047.00
Max. Negotiated Rate	$2,031.18
Rate for Payer: AlohaCare Medicaid	$1,047.00
Rate for Payer: AlohaCare Medicare	$1,591.44
Rate for Payer: Cash Price	$1,256.40
Rate for Payer: Devoted Health Medicare	$1,758.96
Rate for Payer: Hawaii Medical Service Association Medicare	$1,591.44
Rate for Payer: Hawaii Western Management Group Commercial	$1,465.80
Rate for Payer: Health Management Network Commercial	$1,779.90
Rate for Payer: Humana Medicare	$1,591.44
Rate for Payer: Kaiser Permanente Commercial	$1,884.60
Rate for Payer: Kaiser Permanente Medicaid	$1,067.94
Rate for Payer: Kaiser Permanente Medicare	$1,591.44
Rate for Payer: MDX Hawaii PPO	$2,031.18
Rate for Payer: Ohana Health Plan Medicaid	$1,591.44
Rate for Payer: Ohana Health Plan Medicare	$1,591.44
Rate for Payer: UnitedHealthcare Medicare	$1,591.44
Rate for Payer: University Health Alliance Commercial	$1,172.64

Know your out-of-pocket cost for care.

All Charges