Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE DHS 145D 4H 78MM 281.340

Facility

$2,001.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.56
Max. Negotiated Rate	$1,940.97
Rate for Payer: Cash Price	$1,200.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.70
Rate for Payer: Health Management Network Commercial	$1,700.85
Rate for Payer: Kaiser Permanente Commercial	$1,800.90
Rate for Payer: MDX Hawaii PPO	$1,940.97
Rate for Payer: University Health Alliance Commercial	$1,120.56

PLATE DHS 145D 4H 78MM 281.340

Facility

$2,001.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.50
Max. Negotiated Rate	$1,940.97
Rate for Payer: Kaiser Permanente Medicare	$1,520.76
Rate for Payer: AlohaCare Medicaid	$1,000.50
Rate for Payer: AlohaCare Medicare	$1,520.76
Rate for Payer: Cash Price	$1,200.60
Rate for Payer: Devoted Health Medicare	$1,680.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,520.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.70
Rate for Payer: Health Management Network Commercial	$1,700.85
Rate for Payer: Humana Medicare	$1,520.76
Rate for Payer: Kaiser Permanente Commercial	$1,800.90
Rate for Payer: Kaiser Permanente Medicaid	$1,020.51
Rate for Payer: MDX Hawaii PPO	$1,940.97
Rate for Payer: Ohana Health Plan Medicaid	$1,520.76
Rate for Payer: Ohana Health Plan Medicare	$1,520.76
Rate for Payer: UnitedHealthcare Medicare	$1,520.76
Rate for Payer: University Health Alliance Commercial	$1,120.56

PLATE DHS 150D 4H 78MM 281.440

Facility

$2,001.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.50
Max. Negotiated Rate	$1,940.97
Rate for Payer: AlohaCare Medicaid	$1,000.50
Rate for Payer: AlohaCare Medicare	$1,520.76
Rate for Payer: Cash Price	$1,200.60
Rate for Payer: Devoted Health Medicare	$1,680.84
Rate for Payer: Hawaii Medical Service Association Medicare	$1,520.76
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.70
Rate for Payer: Health Management Network Commercial	$1,700.85
Rate for Payer: Humana Medicare	$1,520.76
Rate for Payer: Kaiser Permanente Commercial	$1,800.90
Rate for Payer: Kaiser Permanente Medicaid	$1,020.51
Rate for Payer: Kaiser Permanente Medicare	$1,520.76
Rate for Payer: MDX Hawaii PPO	$1,940.97
Rate for Payer: Ohana Health Plan Medicaid	$1,520.76
Rate for Payer: Ohana Health Plan Medicare	$1,520.76
Rate for Payer: UnitedHealthcare Medicare	$1,520.76
Rate for Payer: University Health Alliance Commercial	$1,120.56

PLATE DHS 150D 4H 78MM 281.440

Facility

$2,001.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.56
Max. Negotiated Rate	$1,940.97
Rate for Payer: Cash Price	$1,200.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.70
Rate for Payer: Health Management Network Commercial	$1,700.85
Rate for Payer: Kaiser Permanente Commercial	$1,800.90
Rate for Payer: MDX Hawaii PPO	$1,940.97
Rate for Payer: University Health Alliance Commercial	$1,120.56

PLATE DHS 150D/4H/78MM 281.840

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,215.00
Max. Negotiated Rate	$2,357.10
Rate for Payer: AlohaCare Medicaid	$1,215.00
Rate for Payer: AlohaCare Medicare	$1,846.80
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Devoted Health Medicare	$2,041.20
Rate for Payer: Hawaii Medical Service Association Medicare	$1,846.80
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Humana Medicare	$1,846.80
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: Kaiser Permanente Medicaid	$1,239.30
Rate for Payer: Kaiser Permanente Medicare	$1,846.80
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: Ohana Health Plan Medicaid	$1,846.80
Rate for Payer: Ohana Health Plan Medicare	$1,846.80
Rate for Payer: UnitedHealthcare Medicare	$1,846.80
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DHS 150D/4H/78MM 281.840

Facility

$2,430.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,360.80
Max. Negotiated Rate	$2,357.10
Rate for Payer: Cash Price	$1,458.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,701.00
Rate for Payer: Health Management Network Commercial	$2,065.50
Rate for Payer: Kaiser Permanente Commercial	$2,187.00
Rate for Payer: MDX Hawaii PPO	$2,357.10
Rate for Payer: University Health Alliance Commercial	$1,360.80

PLATE DISTAL 10H/158MM/LEFT

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 DISTAL 10H/158MM/LEFT

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 DISTAL 10H/158MM/RIGHT

Facility

$2,933.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,466.50
Max. Negotiated Rate	$2,845.01
Rate for Payer: AlohaCare Medicaid	$1,466.50
Rate for Payer: AlohaCare Medicare	$2,229.08
Rate for Payer: Cash Price	$1,759.80
Rate for Payer: Devoted Health Medicare	$2,463.72
Rate for Payer: Hawaii Medical Service Association Medicare	$2,229.08
Rate for Payer: Hawaii Western Management Group Commercial	$2,053.10
Rate for Payer: Health Management Network Commercial	$2,493.05
Rate for Payer: Humana Medicare	$2,229.08
Rate for Payer: Kaiser Permanente Commercial	$2,639.70
Rate for Payer: Kaiser Permanente Medicaid	$1,495.83
Rate for Payer: Kaiser Permanente Medicare	$2,229.08
Rate for Payer: MDX Hawaii PPO	$2,845.01
Rate for Payer: Ohana Health Plan Medicaid	$2,229.08
Rate for Payer: Ohana Health Plan Medicare	$2,229.08
Rate for Payer: UnitedHealthcare Medicare	$2,229.08
Rate for Payer: University Health Alliance Commercial	$1,642.48

PLATE DISTAL 10H/158MM/RIGHT

Facility

$2,933.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,642.48
Max. Negotiated Rate	$2,845.01
Rate for Payer: Cash Price	$1,759.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,053.10
Rate for Payer: Health Management Network Commercial	$2,493.05
Rate for Payer: Kaiser Permanente Commercial	$2,639.70
Rate for Payer: MDX Hawaii PPO	$2,845.01
Rate for Payer: University Health Alliance Commercial	$1,642.48

PLATE DISTAL 4H/80MM/LEFT

Facility

$2,200.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,232.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,540.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: University Health Alliance Commercial	$1,232.00

PLATE DISTAL 4H/80MM/LEFT

Facility

$2,200.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$2,134.00
Rate for Payer: AlohaCare Medicaid	$1,100.00
Rate for Payer: AlohaCare Medicare	$1,672.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Devoted Health Medicare	$1,848.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,672.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,540.00
Rate for Payer: Health Management Network Commercial	$1,870.00
Rate for Payer: Humana Medicare	$1,672.00
Rate for Payer: Kaiser Permanente Commercial	$1,980.00
Rate for Payer: Kaiser Permanente Medicaid	$1,122.00
Rate for Payer: Kaiser Permanente Medicare	$1,672.00
Rate for Payer: MDX Hawaii PPO	$2,134.00
Rate for Payer: Ohana Health Plan Medicaid	$1,672.00
Rate for Payer: Ohana Health Plan Medicare	$1,672.00
Rate for Payer: UnitedHealthcare Medicare	$1,672.00
Rate for Payer: University Health Alliance Commercial	$1,232.00

PLATE DISTAL 4H/80MM/RIGHT

Facility

$3,220.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,803.20
Max. Negotiated Rate	$3,123.40
Rate for Payer: Cash Price	$1,932.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,254.00
Rate for Payer: Health Management Network Commercial	$2,737.00
Rate for Payer: Kaiser Permanente Commercial	$2,898.00
Rate for Payer: MDX Hawaii PPO	$3,123.40
Rate for Payer: University Health Alliance Commercial	$1,803.20

PLATE DISTAL 4H/80MM/RIGHT

Facility

$3,220.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,610.00
Max. Negotiated Rate	$3,123.40
Rate for Payer: AlohaCare Medicaid	$1,610.00
Rate for Payer: AlohaCare Medicare	$2,447.20
Rate for Payer: Cash Price	$1,932.00
Rate for Payer: Devoted Health Medicare	$2,704.80
Rate for Payer: Hawaii Medical Service Association Medicare	$2,447.20
Rate for Payer: Hawaii Western Management Group Commercial	$2,254.00
Rate for Payer: Health Management Network Commercial	$2,737.00
Rate for Payer: Humana Medicare	$2,447.20
Rate for Payer: Kaiser Permanente Commercial	$2,898.00
Rate for Payer: Kaiser Permanente Medicaid	$1,642.20
Rate for Payer: Kaiser Permanente Medicare	$2,447.20
Rate for Payer: MDX Hawaii PPO	$3,123.40
Rate for Payer: Ohana Health Plan Medicaid	$2,447.20
Rate for Payer: Ohana Health Plan Medicare	$2,447.20
Rate for Payer: UnitedHealthcare Medicare	$2,447.20
Rate for Payer: University Health Alliance Commercial	$1,803.20

PLATE DISTAL 8H/132MM/LEFT

Facility

$2,754.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,377.00
Max. Negotiated Rate	$2,671.38
Rate for Payer: AlohaCare Medicaid	$1,377.00
Rate for Payer: AlohaCare Medicare	$2,093.04
Rate for Payer: Cash Price	$1,652.40
Rate for Payer: Devoted Health Medicare	$2,313.36
Rate for Payer: Hawaii Medical Service Association Medicare	$2,093.04
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.80
Rate for Payer: Health Management Network Commercial	$2,340.90
Rate for Payer: Humana Medicare	$2,093.04
Rate for Payer: Kaiser Permanente Commercial	$2,478.60
Rate for Payer: Kaiser Permanente Medicaid	$1,404.54
Rate for Payer: Kaiser Permanente Medicare	$2,093.04
Rate for Payer: MDX Hawaii PPO	$2,671.38
Rate for Payer: Ohana Health Plan Medicaid	$2,093.04
Rate for Payer: Ohana Health Plan Medicare	$2,093.04
Rate for Payer: UnitedHealthcare Medicare	$2,093.04
Rate for Payer: University Health Alliance Commercial	$1,542.24

PLATE DISTAL 8H/132MM/LEFT

Facility

$2,754.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,542.24
Max. Negotiated Rate	$2,671.38
Rate for Payer: Cash Price	$1,652.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,927.80
Rate for Payer: Health Management Network Commercial	$2,340.90
Rate for Payer: Kaiser Permanente Commercial	$2,478.60
Rate for Payer: MDX Hawaii PPO	$2,671.38
Rate for Payer: University Health Alliance Commercial	$1,542.24

PLATE DISTAL 8H/132MM/RIGHT

Facility

$2,410.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,205.00
Max. Negotiated Rate	$2,337.70
Rate for Payer: AlohaCare Medicaid	$1,205.00
Rate for Payer: AlohaCare Medicare	$1,831.60
Rate for Payer: Cash Price	$1,446.00
Rate for Payer: Devoted Health Medicare	$2,024.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,831.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.00
Rate for Payer: Health Management Network Commercial	$2,048.50
Rate for Payer: Humana Medicare	$1,831.60
Rate for Payer: Kaiser Permanente Commercial	$2,169.00
Rate for Payer: Kaiser Permanente Medicaid	$1,229.10
Rate for Payer: Kaiser Permanente Medicare	$1,831.60
Rate for Payer: MDX Hawaii PPO	$2,337.70
Rate for Payer: Ohana Health Plan Medicaid	$1,831.60
Rate for Payer: Ohana Health Plan Medicare	$1,831.60
Rate for Payer: UnitedHealthcare Medicare	$1,831.60
Rate for Payer: University Health Alliance Commercial	$1,349.60

PLATE DISTAL 8H/132MM/RIGHT

Facility

$2,410.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,349.60
Max. Negotiated Rate	$2,337.70
Rate for Payer: Cash Price	$1,446.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,687.00
Rate for Payer: Health Management Network Commercial	$2,048.50
Rate for Payer: Kaiser Permanente Commercial	$2,169.00
Rate for Payer: MDX Hawaii PPO	$2,337.70
Rate for Payer: University Health Alliance Commercial	$1,349.60

PLATE DISTAL FEMUR 166 6H

Facility

$4,503.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,251.50
Max. Negotiated Rate	$4,367.91
Rate for Payer: AlohaCare Medicaid	$2,251.50
Rate for Payer: AlohaCare Medicare	$3,422.28
Rate for Payer: Cash Price	$2,701.80
Rate for Payer: Devoted Health Medicare	$3,782.52
Rate for Payer: Hawaii Medical Service Association Medicare	$3,422.28
Rate for Payer: Hawaii Western Management Group Commercial	$3,152.10
Rate for Payer: Health Management Network Commercial	$3,827.55
Rate for Payer: Humana Medicare	$3,422.28
Rate for Payer: Kaiser Permanente Commercial	$4,052.70
Rate for Payer: Kaiser Permanente Medicaid	$2,296.53
Rate for Payer: Kaiser Permanente Medicare	$3,422.28
Rate for Payer: MDX Hawaii PPO	$4,367.91
Rate for Payer: Ohana Health Plan Medicaid	$3,422.28
Rate for Payer: Ohana Health Plan Medicare	$3,422.28
Rate for Payer: UnitedHealthcare Medicare	$3,422.28
Rate for Payer: University Health Alliance Commercial	$2,521.68

PLATE DISTAL FEMUR 166 6H

Facility

$4,503.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,521.68
Max. Negotiated Rate	$4,367.91
Rate for Payer: Cash Price	$2,701.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,152.10
Rate for Payer: Health Management Network Commercial	$3,827.55
Rate for Payer: Kaiser Permanente Commercial	$4,052.70
Rate for Payer: MDX Hawaii PPO	$4,367.91
Rate for Payer: University Health Alliance Commercial	$2,521.68

PLATE DISTAL FIB AR-8943DR-08

Facility

$2,756.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,543.36
Max. Negotiated Rate	$2,673.32
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,929.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: University Health Alliance Commercial	$1,543.36

PLATE DISTAL FIB AR-8943DR-08

Facility

$2,756.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,378.00
Max. Negotiated Rate	$2,673.32
Rate for Payer: AlohaCare Medicaid	$1,378.00
Rate for Payer: AlohaCare Medicare	$2,094.56
Rate for Payer: Cash Price	$1,653.60
Rate for Payer: Devoted Health Medicare	$2,315.04
Rate for Payer: Hawaii Medical Service Association Medicare	$2,094.56
Rate for Payer: Hawaii Western Management Group Commercial	$1,929.20
Rate for Payer: Health Management Network Commercial	$2,342.60
Rate for Payer: Humana Medicare	$2,094.56
Rate for Payer: Kaiser Permanente Commercial	$2,480.40
Rate for Payer: Kaiser Permanente Medicaid	$1,405.56
Rate for Payer: Kaiser Permanente Medicare	$2,094.56
Rate for Payer: MDX Hawaii PPO	$2,673.32
Rate for Payer: Ohana Health Plan Medicaid	$2,094.56
Rate for Payer: Ohana Health Plan Medicare	$2,094.56
Rate for Payer: UnitedHealthcare Medicare	$2,094.56
Rate for Payer: University Health Alliance Commercial	$1,543.36

PLATE DISTAL LATERA FIB 540648

Facility

$3,690.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,845.00
Max. Negotiated Rate	$3,579.30
Rate for Payer: AlohaCare Medicaid	$1,845.00
Rate for Payer: AlohaCare Medicare	$2,804.40
Rate for Payer: Cash Price	$2,214.00
Rate for Payer: Devoted Health Medicare	$3,099.60
Rate for Payer: Hawaii Medical Service Association Medicare	$2,804.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,583.00
Rate for Payer: Health Management Network Commercial	$3,136.50
Rate for Payer: Humana Medicare	$2,804.40
Rate for Payer: Kaiser Permanente Commercial	$3,321.00
Rate for Payer: Kaiser Permanente Medicaid	$1,881.90
Rate for Payer: Kaiser Permanente Medicare	$2,804.40
Rate for Payer: MDX Hawaii PPO	$3,579.30
Rate for Payer: Ohana Health Plan Medicaid	$2,804.40
Rate for Payer: Ohana Health Plan Medicare	$2,804.40
Rate for Payer: UnitedHealthcare Medicare	$2,804.40
Rate for Payer: University Health Alliance Commercial	$2,066.40

PLATE DISTAL LATERA FIB 540648

Facility

$3,690.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,066.40
Max. Negotiated Rate	$3,579.30
Rate for Payer: Cash Price	$2,214.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,583.00
Rate for Payer: Health Management Network Commercial	$3,136.50
Rate for Payer: Kaiser Permanente Commercial	$3,321.00
Rate for Payer: MDX Hawaii PPO	$3,579.30
Rate for Payer: University Health Alliance Commercial	$2,066.40

PLATE DISTAL LATERAL 40-20908

Facility

$2,172.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,216.32
Max. Negotiated Rate	$2,106.84
Rate for Payer: Cash Price	$1,303.20
Rate for Payer: Hawaii Western Management Group Commercial	$1,520.40
Rate for Payer: Health Management Network Commercial	$1,846.20
Rate for Payer: Kaiser Permanente Commercial	$1,954.80
Rate for Payer: MDX Hawaii PPO	$2,106.84
Rate for Payer: University Health Alliance Commercial	$1,216.32

Know your out-of-pocket cost for care.

All Charges