Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE DISTAL LATERAL 40-20908

Facility

$2,172.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,086.00
Max. Negotiated Rate	$2,106.84
Rate for Payer: AlohaCare Medicaid	$1,086.00
Rate for Payer: AlohaCare Medicare	$1,650.72
Rate for Payer: Cash Price	$1,303.20
Rate for Payer: Devoted Health Medicare	$1,824.48
Rate for Payer: Hawaii Medical Service Association Medicare	$1,650.72
Rate for Payer: Hawaii Western Management Group Commercial	$1,520.40
Rate for Payer: Health Management Network Commercial	$1,846.20
Rate for Payer: Humana Medicare	$1,650.72
Rate for Payer: Kaiser Permanente Commercial	$1,954.80
Rate for Payer: Kaiser Permanente Medicaid	$1,107.72
Rate for Payer: Kaiser Permanente Medicare	$1,650.72
Rate for Payer: MDX Hawaii PPO	$2,106.84
Rate for Payer: Ohana Health Plan Medicaid	$1,650.72
Rate for Payer: Ohana Health Plan Medicare	$1,650.72
Rate for Payer: UnitedHealthcare Medicare	$1,650.72
Rate for Payer: University Health Alliance Commercial	$1,216.32

PLATE DISTAL LATERAL FEMUR

Facility

$4,810.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,405.00
Max. Negotiated Rate	$4,665.70
Rate for Payer: AlohaCare Medicaid	$2,405.00
Rate for Payer: AlohaCare Medicare	$3,655.60
Rate for Payer: Cash Price	$2,886.00
Rate for Payer: Devoted Health Medicare	$4,040.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,655.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,367.00
Rate for Payer: Health Management Network Commercial	$4,088.50
Rate for Payer: Humana Medicare	$3,655.60
Rate for Payer: Kaiser Permanente Commercial	$4,329.00
Rate for Payer: Kaiser Permanente Medicaid	$2,453.10
Rate for Payer: Kaiser Permanente Medicare	$3,655.60
Rate for Payer: MDX Hawaii PPO	$4,665.70
Rate for Payer: Ohana Health Plan Medicaid	$3,655.60
Rate for Payer: Ohana Health Plan Medicare	$3,655.60
Rate for Payer: UnitedHealthcare Medicare	$3,655.60
Rate for Payer: University Health Alliance Commercial	$2,693.60

PLATE DISTAL LATERAL FEMUR

Facility

$4,810.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,693.60
Max. Negotiated Rate	$4,665.70
Rate for Payer: Cash Price	$2,886.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,367.00
Rate for Payer: Health Management Network Commercial	$4,088.50
Rate for Payer: Kaiser Permanente Commercial	$4,329.00
Rate for Payer: MDX Hawaii PPO	$4,665.70
Rate for Payer: University Health Alliance Commercial	$2,693.60

PLATE DISTAL LATERAL FEMUR RT

Facility

$4,604.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,578.24
Max. Negotiated Rate	$4,465.88
Rate for Payer: Cash Price	$2,762.40
Rate for Payer: Cash Price	$3,009.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,510.50
Rate for Payer: Hawaii Western Management Group Commercial	$3,222.80
Rate for Payer: Health Management Network Commercial	$4,262.75
Rate for Payer: Health Management Network Commercial	$3,913.40
Rate for Payer: Kaiser Permanente Commercial	$4,513.50
Rate for Payer: Kaiser Permanente Commercial	$4,143.60
Rate for Payer: MDX Hawaii PPO	$4,864.55
Rate for Payer: MDX Hawaii PPO	$4,465.88
Rate for Payer: University Health Alliance Commercial	$2,808.40
Rate for Payer: University Health Alliance Commercial	$2,578.24

PLATE DISTAL LATERAL FEMUR RT

Facility

$5,015.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,507.50
Max. Negotiated Rate	$4,864.55
Rate for Payer: AlohaCare Medicaid	$2,507.50
Rate for Payer: AlohaCare Medicaid	$2,302.00
Rate for Payer: AlohaCare Medicare	$3,811.40
Rate for Payer: AlohaCare Medicare	$3,499.04
Rate for Payer: Cash Price	$2,762.40
Rate for Payer: Cash Price	$3,009.00
Rate for Payer: Devoted Health Medicare	$3,867.36
Rate for Payer: Devoted Health Medicare	$4,212.60
Rate for Payer: Hawaii Medical Service Association Medicare	$3,499.04
Rate for Payer: Hawaii Medical Service Association Medicare	$3,811.40
Rate for Payer: Hawaii Western Management Group Commercial	$3,222.80
Rate for Payer: Hawaii Western Management Group Commercial	$3,510.50
Rate for Payer: Health Management Network Commercial	$4,262.75
Rate for Payer: Health Management Network Commercial	$3,913.40
Rate for Payer: Humana Medicare	$3,811.40
Rate for Payer: Humana Medicare	$3,499.04
Rate for Payer: Kaiser Permanente Commercial	$4,143.60
Rate for Payer: Kaiser Permanente Commercial	$4,513.50
Rate for Payer: Kaiser Permanente Medicaid	$2,348.04
Rate for Payer: Kaiser Permanente Medicaid	$2,557.65
Rate for Payer: Kaiser Permanente Medicare	$3,811.40
Rate for Payer: Kaiser Permanente Medicare	$3,499.04
Rate for Payer: MDX Hawaii PPO	$4,465.88
Rate for Payer: MDX Hawaii PPO	$4,864.55
Rate for Payer: Ohana Health Plan Medicaid	$3,811.40
Rate for Payer: Ohana Health Plan Medicaid	$3,499.04
Rate for Payer: Ohana Health Plan Medicare	$3,811.40
Rate for Payer: Ohana Health Plan Medicare	$3,499.04
Rate for Payer: UnitedHealthcare Medicare	$3,499.04
Rate for Payer: UnitedHealthcare Medicare	$3,811.40
Rate for Payer: University Health Alliance Commercial	$2,808.40
Rate for Payer: University Health Alliance Commercial	$2,578.24

PLATE DISTAL LF 8H AR-2657DL

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 DISTAL LF 8H AR-2657DL

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 DISTAL LT 6H 626246

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 DISTAL LT 6H 626246

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 DISTAL MEDIAL LF 627410

Facility

$3,786.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,120.16
Max. Negotiated Rate	$3,672.42
Rate for Payer: Cash Price	$2,271.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,650.20
Rate for Payer: Health Management Network Commercial	$3,218.10
Rate for Payer: Kaiser Permanente Commercial	$3,407.40
Rate for Payer: MDX Hawaii PPO	$3,672.42
Rate for Payer: University Health Alliance Commercial	$2,120.16

PLATE DISTAL MEDIAL LF 627410

Facility

$3,786.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,893.00
Max. Negotiated Rate	$3,672.42
Rate for Payer: AlohaCare Medicaid	$1,893.00
Rate for Payer: AlohaCare Medicare	$2,877.36
Rate for Payer: Cash Price	$2,271.60
Rate for Payer: Devoted Health Medicare	$3,180.24
Rate for Payer: Hawaii Medical Service Association Medicare	$2,877.36
Rate for Payer: Hawaii Western Management Group Commercial	$2,650.20
Rate for Payer: Health Management Network Commercial	$3,218.10
Rate for Payer: Humana Medicare	$2,877.36
Rate for Payer: Kaiser Permanente Commercial	$3,407.40
Rate for Payer: Kaiser Permanente Medicaid	$1,930.86
Rate for Payer: Kaiser Permanente Medicare	$2,877.36
Rate for Payer: MDX Hawaii PPO	$3,672.42
Rate for Payer: Ohana Health Plan Medicaid	$2,877.36
Rate for Payer: Ohana Health Plan Medicare	$2,877.36
Rate for Payer: UnitedHealthcare Medicare	$2,877.36
Rate for Payer: University Health Alliance Commercial	$2,120.16

PLATE DISTAL POST 629263

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

PLATE DISTAL POST 629263

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 DISTAL POSTERIOR LF

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

PLATE DISTAL POSTERIOR LF

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 DISTAL THIRD RT 8H

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 DISTAL THIRD RT 8H

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 DISTAL TIB RT 627438

Facility

$3,684.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,842.00
Max. Negotiated Rate	$3,573.48
Rate for Payer: AlohaCare Medicaid	$1,842.00
Rate for Payer: AlohaCare Medicare	$2,799.84
Rate for Payer: Cash Price	$2,210.40
Rate for Payer: Devoted Health Medicare	$3,094.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2,799.84
Rate for Payer: Hawaii Western Management Group Commercial	$2,578.80
Rate for Payer: Health Management Network Commercial	$3,131.40
Rate for Payer: Humana Medicare	$2,799.84
Rate for Payer: Kaiser Permanente Commercial	$3,315.60
Rate for Payer: Kaiser Permanente Medicaid	$1,878.84
Rate for Payer: Kaiser Permanente Medicare	$2,799.84
Rate for Payer: MDX Hawaii PPO	$3,573.48
Rate for Payer: Ohana Health Plan Medicaid	$2,799.84
Rate for Payer: Ohana Health Plan Medicare	$2,799.84
Rate for Payer: UnitedHealthcare Medicare	$2,799.84
Rate for Payer: University Health Alliance Commercial	$2,063.04

PLATE DISTAL TIB RT 627438

Facility

$3,684.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,063.04
Max. Negotiated Rate	$3,573.48
Rate for Payer: Cash Price	$2,210.40
Rate for Payer: Hawaii Western Management Group Commercial	$2,578.80
Rate for Payer: Health Management Network Commercial	$3,131.40
Rate for Payer: Kaiser Permanente Commercial	$3,315.60
Rate for Payer: MDX Hawaii PPO	$3,573.48
Rate for Payer: University Health Alliance Commercial	$2,063.04

PLATE DIST LAT 89MM 40-20904

Facility

$2,891.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,445.50
Max. Negotiated Rate	$2,804.27
Rate for Payer: AlohaCare Medicaid	$1,445.50
Rate for Payer: AlohaCare Medicare	$2,197.16
Rate for Payer: Cash Price	$1,734.60
Rate for Payer: Devoted Health Medicare	$2,428.44
Rate for Payer: Hawaii Medical Service Association Medicare	$2,197.16
Rate for Payer: Hawaii Western Management Group Commercial	$2,023.70
Rate for Payer: Health Management Network Commercial	$2,457.35
Rate for Payer: Humana Medicare	$2,197.16
Rate for Payer: Kaiser Permanente Commercial	$2,601.90
Rate for Payer: Kaiser Permanente Medicaid	$1,474.41
Rate for Payer: Kaiser Permanente Medicare	$2,197.16
Rate for Payer: MDX Hawaii PPO	$2,804.27
Rate for Payer: Ohana Health Plan Medicaid	$2,197.16
Rate for Payer: Ohana Health Plan Medicare	$2,197.16
Rate for Payer: UnitedHealthcare Medicare	$2,197.16
Rate for Payer: University Health Alliance Commercial	$1,618.96

PLATE DIST LAT 89MM 40-20904

Facility

$2,891.00

Service Code	HCPCS C1776
Hospital Revenue Code	278
Min. Negotiated Rate	$1,618.96
Max. Negotiated Rate	$2,804.27
Rate for Payer: Cash Price	$1,734.60
Rate for Payer: Hawaii Western Management Group Commercial	$2,023.70
Rate for Payer: Health Management Network Commercial	$2,457.35
Rate for Payer: Kaiser Permanente Commercial	$2,601.90
Rate for Payer: MDX Hawaii PPO	$2,804.27
Rate for Payer: University Health Alliance Commercial	$1,618.96

PLATE DISTL POST 128 6H 629246

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 DISTL POST 128 6H 629246

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 DORSAL/ULNAR 3H DUP3

Facility

$2,385.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$2,313.45
Rate for Payer: AlohaCare Medicaid	$1,192.50
Rate for Payer: AlohaCare Medicare	$1,812.60
Rate for Payer: Cash Price	$1,431.00
Rate for Payer: Devoted Health Medicare	$2,003.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,812.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.50
Rate for Payer: Health Management Network Commercial	$2,027.25
Rate for Payer: Humana Medicare	$1,812.60
Rate for Payer: Kaiser Permanente Commercial	$2,146.50
Rate for Payer: Kaiser Permanente Medicaid	$1,216.35
Rate for Payer: Kaiser Permanente Medicare	$1,812.60
Rate for Payer: MDX Hawaii PPO	$2,313.45
Rate for Payer: Ohana Health Plan Medicaid	$1,812.60
Rate for Payer: Ohana Health Plan Medicare	$1,812.60
Rate for Payer: UnitedHealthcare Medicare	$1,812.60
Rate for Payer: University Health Alliance Commercial	$1,335.60

PLATE DORSAL/ULNAR 3H DUP3

Facility

$2,385.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,335.60
Max. Negotiated Rate	$2,313.45
Rate for Payer: Cash Price	$1,431.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,669.50
Rate for Payer: Health Management Network Commercial	$2,027.25
Rate for Payer: Kaiser Permanente Commercial	$2,146.50
Rate for Payer: MDX Hawaii PPO	$2,313.45
Rate for Payer: University Health Alliance Commercial	$1,335.60

Know your out-of-pocket cost for care.

All Charges