Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE BUTTRES-T 5H 96MM 240.35

Facility

$2,202.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,233.12
Max. Negotiated Rate	$2,135.94
Rate for Payer: Cash Price	$1,321.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,541.40
Rate for Payer: Health Management Network Commercial	$1,871.70
Rate for Payer: Kaiser Permanente Commercial	$1,981.80
Rate for Payer: MDX Hawaii PPO	$2,135.94
Rate for Payer: University Health Alliance Commercial	$1,233.12

PLATE BUTTRES-T 5H 96MM 240.35

Facility

$2,202.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,101.00
Max. Negotiated Rate	$2,135.94
Rate for Payer: AlohaCare Medicaid	$1,101.00
Rate for Payer: AlohaCare Medicare	$1,673.52
Rate for Payer: Cash Price	$1,321.20
Rate for Payer: Devoted Health Medicare	$1,849.68
Rate for Payer: Hawaii Medical Service Association Medicare	$1,673.52
Rate for Payer: Hawaii Western Management Group Commercial	$1,541.40
Rate for Payer: Health Management Network Commercial	$1,871.70
Rate for Payer: Humana Medicare	$1,673.52
Rate for Payer: Kaiser Permanente Commercial	$1,981.80
Rate for Payer: Kaiser Permanente Medicaid	$1,123.02
Rate for Payer: Kaiser Permanente Medicare	$1,673.52
Rate for Payer: MDX Hawaii PPO	$2,135.94
Rate for Payer: Ohana Health Plan Medicaid	$1,673.52
Rate for Payer: Ohana Health Plan Medicare	$1,673.52
Rate for Payer: UnitedHealthcare Medicare	$1,673.52
Rate for Payer: University Health Alliance Commercial	$1,233.12

PLATE CALCANEAL64MM02.211.403

Facility

$2,296.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,285.76
Max. Negotiated Rate	$2,227.12
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.20
Rate for Payer: Health Management Network Commercial	$1,951.60
Rate for Payer: Kaiser Permanente Commercial	$2,066.40
Rate for Payer: MDX Hawaii PPO	$2,227.12
Rate for Payer: University Health Alliance Commercial	$1,285.76

PLATE CALCANEAL64MM02.211.403

Facility

$2,296.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,148.00
Max. Negotiated Rate	$2,227.12
Rate for Payer: AlohaCare Medicaid	$1,148.00
Rate for Payer: AlohaCare Medicare	$1,744.96
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Devoted Health Medicare	$1,928.64
Rate for Payer: Hawaii Medical Service Association Medicare	$1,744.96
Rate for Payer: Hawaii Western Management Group Commercial	$1,607.20
Rate for Payer: Health Management Network Commercial	$1,951.60
Rate for Payer: Humana Medicare	$1,744.96
Rate for Payer: Kaiser Permanente Commercial	$2,066.40
Rate for Payer: Kaiser Permanente Medicaid	$1,170.96
Rate for Payer: Kaiser Permanente Medicare	$1,744.96
Rate for Payer: MDX Hawaii PPO	$2,227.12
Rate for Payer: Ohana Health Plan Medicaid	$1,744.96
Rate for Payer: Ohana Health Plan Medicare	$1,744.96
Rate for Payer: UnitedHealthcare Medicare	$1,744.96
Rate for Payer: University Health Alliance Commercial	$1,285.76

PLATE CALCANEAL70MM 02.211.404

Facility

$2,313.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,295.28
Max. Negotiated Rate	$2,243.61
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,619.10
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: University Health Alliance Commercial	$1,295.28

PLATE CALCANEAL70MM 02.211.404

Facility

$2,313.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,156.50
Max. Negotiated Rate	$2,243.61
Rate for Payer: AlohaCare Medicaid	$1,156.50
Rate for Payer: AlohaCare Medicare	$1,757.88
Rate for Payer: Cash Price	$1,387.80
Rate for Payer: Devoted Health Medicare	$1,942.92
Rate for Payer: Hawaii Medical Service Association Medicare	$1,757.88
Rate for Payer: Hawaii Western Management Group Commercial	$1,619.10
Rate for Payer: Health Management Network Commercial	$1,966.05
Rate for Payer: Humana Medicare	$1,757.88
Rate for Payer: Kaiser Permanente Commercial	$2,081.70
Rate for Payer: Kaiser Permanente Medicaid	$1,179.63
Rate for Payer: Kaiser Permanente Medicare	$1,757.88
Rate for Payer: MDX Hawaii PPO	$2,243.61
Rate for Payer: Ohana Health Plan Medicaid	$1,757.88
Rate for Payer: Ohana Health Plan Medicare	$1,757.88
Rate for Payer: UnitedHealthcare Medicare	$1,757.88
Rate for Payer: University Health Alliance Commercial	$1,295.28

PLATE CALC SHORT-LEFT 241.625

Facility

$2,274.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,137.00
Max. Negotiated Rate	$2,205.78
Rate for Payer: AlohaCare Medicaid	$1,137.00
Rate for Payer: AlohaCare Medicare	$1,728.24
Rate for Payer: Cash Price	$1,364.40
Rate for Payer: Devoted Health Medicare	$1,910.16
Rate for Payer: Hawaii Medical Service Association Medicare	$1,728.24
Rate for Payer: Hawaii Western Management Group Commercial	$1,591.80
Rate for Payer: Health Management Network Commercial	$1,932.90
Rate for Payer: Humana Medicare	$1,728.24
Rate for Payer: Kaiser Permanente Commercial	$2,046.60
Rate for Payer: Kaiser Permanente Medicaid	$1,159.74
Rate for Payer: Kaiser Permanente Medicare	$1,728.24
Rate for Payer: MDX Hawaii PPO	$2,205.78
Rate for Payer: Ohana Health Plan Medicaid	$1,728.24
Rate for Payer: Ohana Health Plan Medicare	$1,728.24
Rate for Payer: UnitedHealthcare Medicare	$1,728.24
Rate for Payer: University Health Alliance Commercial	$1,273.44

PLATE CALC SHORT-LEFT 241.625

Facility

$2,274.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,273.44
Max. Negotiated Rate	$2,205.78
Rate for Payer: Cash Price	$1,364.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,591.80
Rate for Payer: Health Management Network Commercial	$1,932.90
Rate for Payer: Kaiser Permanente Commercial	$2,046.60
Rate for Payer: MDX Hawaii PPO	$2,205.78
Rate for Payer: University Health Alliance Commercial	$1,273.44

PLATE CENTRAL R SM AR-2652CR

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CENTRAL R SM AR-2652CR

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.00
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$1,339.00
Rate for Payer: AlohaCare Medicare	$2,035.28
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$2,249.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,035.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$2,035.28
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$2,035.28
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$2,035.28
Rate for Payer: Ohana Health Plan Medicare	$2,035.28
Rate for Payer: UnitedHealthcare Medicare	$2,035.28
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CENTRAL THIRD AR-2654CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
Max. Negotiated Rate	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CENTRAL THIRD AR-2654CL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.00
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$1,339.00
Rate for Payer: AlohaCare Medicare	$2,035.28
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$2,249.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,035.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$2,035.28
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$2,035.28
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$2,035.28
Rate for Payer: Ohana Health Plan Medicare	$2,035.28
Rate for Payer: UnitedHealthcare Medicare	$2,035.28
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CLAVICEL RT 6H 628026

Facility

$2,381.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,190.50
Max. Negotiated Rate	$2,309.57
Rate for Payer: AlohaCare Medicaid	$1,190.50
Rate for Payer: AlohaCare Medicare	$1,809.56
Rate for Payer: Cash Price	$1,428.60
Rate for Payer: Devoted Health Medicare	$2,000.04
Rate for Payer: Hawaii Medical Service Association Medicare	$1,809.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,666.70
Rate for Payer: Health Management Network Commercial	$2,023.85
Rate for Payer: Humana Medicare	$1,809.56
Rate for Payer: Kaiser Permanente Commercial	$2,142.90
Rate for Payer: Kaiser Permanente Medicaid	$1,214.31
Rate for Payer: Kaiser Permanente Medicare	$1,809.56
Rate for Payer: MDX Hawaii PPO	$2,309.57
Rate for Payer: Ohana Health Plan Medicaid	$1,809.56
Rate for Payer: Ohana Health Plan Medicare	$1,809.56
Rate for Payer: UnitedHealthcare Medicare	$1,809.56
Rate for Payer: University Health Alliance Commercial	$1,333.36

PLATE CLAVICEL RT 6H 628026

Facility

$2,381.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,333.36
Max. Negotiated Rate	$2,309.57
Rate for Payer: Cash Price	$1,428.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,666.70
Rate for Payer: Health Management Network Commercial	$2,023.85
Rate for Payer: Kaiser Permanente Commercial	$2,142.90
Rate for Payer: MDX Hawaii PPO	$2,309.57
Rate for Payer: University Health Alliance Commercial	$1,333.36

PLATE CLAVICLE 3RD L AR-2656DL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.00
Max. Negotiated Rate	$2,597.66
Rate for Payer: AlohaCare Medicaid	$1,339.00
Rate for Payer: AlohaCare Medicare	$2,035.28
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Devoted Health Medicare	$2,249.52
Rate for Payer: Hawaii Medical Service Association Medicare	$2,035.28
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Humana Medicare	$2,035.28
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: Kaiser Permanente Medicaid	$1,365.78
Rate for Payer: Kaiser Permanente Medicare	$2,035.28
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Ohana Health Plan Medicaid	$2,035.28
Rate for Payer: Ohana Health Plan Medicare	$2,035.28
Rate for Payer: UnitedHealthcare Medicare	$2,035.28
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CLAVICLE 3RD L AR-2656DL

Facility

$2,678.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,499.68
Max. Negotiated Rate	$2,597.66
Rate for Payer: MDX Hawaii PPO	$2,597.66
Rate for Payer: Cash Price	$1,606.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,874.60
Rate for Payer: Health Management Network Commercial	$2,276.30
Rate for Payer: Kaiser Permanente Commercial	$2,410.20
Rate for Payer: University Health Alliance Commercial	$1,499.68

PLATE CLAVICLE 628008

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$3,346.50
Rate for Payer: AlohaCare Medicaid	$1,725.00
Rate for Payer: AlohaCare Medicare	$2,622.00
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Devoted Health Medicare	$2,898.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,622.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: Humana Medicare	$2,622.00
Rate for Payer: Kaiser Permanente Commercial	$3,105.00
Rate for Payer: Kaiser Permanente Medicaid	$1,759.50
Rate for Payer: Kaiser Permanente Medicare	$2,622.00
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: Ohana Health Plan Medicaid	$2,622.00
Rate for Payer: Ohana Health Plan Medicare	$2,622.00
Rate for Payer: UnitedHealthcare Medicare	$2,622.00
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLAVICLE 628008

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,932.00
Max. Negotiated Rate	$3,346.50
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: Kaiser Permanente Commercial	$3,105.00
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLAVICLE 628108

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,932.00
Max. Negotiated Rate	$3,346.50
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: Kaiser Permanente Commercial	$3,105.00
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLAVICLE 628108

Facility

$3,450.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,725.00
Max. Negotiated Rate	$3,346.50
Rate for Payer: AlohaCare Medicaid	$1,725.00
Rate for Payer: AlohaCare Medicare	$2,622.00
Rate for Payer: Cash Price	$2,070.00
Rate for Payer: Devoted Health Medicare	$2,898.00
Rate for Payer: Hawaii Medical Service Association Medicare	$2,622.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,415.00
Rate for Payer: Health Management Network Commercial	$2,932.50
Rate for Payer: Humana Medicare	$2,622.00
Rate for Payer: Kaiser Permanente Commercial	$3,105.00
Rate for Payer: Kaiser Permanente Medicaid	$1,759.50
Rate for Payer: Kaiser Permanente Medicare	$2,622.00
Rate for Payer: MDX Hawaii PPO	$3,346.50
Rate for Payer: Ohana Health Plan Medicaid	$2,622.00
Rate for Payer: Ohana Health Plan Medicare	$2,622.00
Rate for Payer: UnitedHealthcare Medicare	$2,622.00
Rate for Payer: University Health Alliance Commercial	$1,932.00

PLATE CLUSTER CLST-6-6

Facility

$2,230.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,248.80
Max. Negotiated Rate	$2,163.10
Rate for Payer: Cash Price	$1,338.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,561.00
Rate for Payer: Health Management Network Commercial	$1,895.50
Rate for Payer: Kaiser Permanente Commercial	$2,007.00
Rate for Payer: MDX Hawaii PPO	$2,163.10
Rate for Payer: University Health Alliance Commercial	$1,248.80

PLATE CLUSTER CLST-6-6

Facility

$2,230.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,115.00
Max. Negotiated Rate	$2,163.10
Rate for Payer: AlohaCare Medicaid	$1,115.00
Rate for Payer: AlohaCare Medicare	$1,694.80
Rate for Payer: Cash Price	$1,338.00
Rate for Payer: Devoted Health Medicare	$1,873.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,694.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,561.00
Rate for Payer: Health Management Network Commercial	$1,895.50
Rate for Payer: Humana Medicare	$1,694.80
Rate for Payer: Kaiser Permanente Commercial	$2,007.00
Rate for Payer: Kaiser Permanente Medicaid	$1,137.30
Rate for Payer: Kaiser Permanente Medicare	$1,694.80
Rate for Payer: MDX Hawaii PPO	$2,163.10
Rate for Payer: Ohana Health Plan Medicaid	$1,694.80
Rate for Payer: Ohana Health Plan Medicare	$1,694.80
Rate for Payer: UnitedHealthcare Medicare	$1,694.80
Rate for Payer: University Health Alliance Commercial	$1,248.80

PLATE COMPRESSION 7HOLE 629507

Facility

$1,976.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,106.56
Max. Negotiated Rate	$1,916.72
Rate for Payer: Cash Price	$1,185.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.20
Rate for Payer: Health Management Network Commercial	$1,679.60
Rate for Payer: Kaiser Permanente Commercial	$1,778.40
Rate for Payer: MDX Hawaii PPO	$1,916.72
Rate for Payer: University Health Alliance Commercial	$1,106.56

PLATE COMPRESSION 7HOLE 629507

Facility

$1,976.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$988.00
Max. Negotiated Rate	$1,916.72
Rate for Payer: AlohaCare Medicaid	$988.00
Rate for Payer: AlohaCare Medicare	$1,501.76
Rate for Payer: Cash Price	$1,185.60
Rate for Payer: Devoted Health Medicare	$1,659.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,501.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,383.20
Rate for Payer: Health Management Network Commercial	$1,679.60
Rate for Payer: Humana Medicare	$1,501.76
Rate for Payer: Kaiser Permanente Commercial	$1,778.40
Rate for Payer: Kaiser Permanente Medicaid	$1,007.76
Rate for Payer: Kaiser Permanente Medicare	$1,501.76
Rate for Payer: MDX Hawaii PPO	$1,916.72
Rate for Payer: Ohana Health Plan Medicaid	$1,501.76
Rate for Payer: Ohana Health Plan Medicare	$1,501.76
Rate for Payer: UnitedHealthcare Medicare	$1,501.76
Rate for Payer: University Health Alliance Commercial	$1,106.56

PLATE CROSSLCK M RT 131812060

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,456.50
Max. Negotiated Rate	$2,825.61
Rate for Payer: AlohaCare Medicaid	$1,456.50
Rate for Payer: AlohaCare Medicare	$2,213.88
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Devoted Health Medicare	$2,446.92
Rate for Payer: Hawaii Medical Service Association Medicare	$2,213.88
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Humana Medicare	$2,213.88
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: Kaiser Permanente Medicaid	$1,485.63
Rate for Payer: Kaiser Permanente Medicare	$2,213.88
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: Ohana Health Plan Medicaid	$2,213.88
Rate for Payer: Ohana Health Plan Medicare	$2,213.88
Rate for Payer: UnitedHealthcare Medicare	$2,213.88
Rate for Payer: University Health Alliance Commercial	$1,631.28

Know your out-of-pocket cost for care.

All Charges