Honoka'a Hospital and Skilled Nursing Facility

All Charges

Charge

Type

Setting

Price

PLATE DORSAL/ULNAR 5H DUP5

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 5H DUP5

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

PLATE DORSAL/ULNAR 7H DUP7

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,120.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PLATE DORSAL/ULNAR 7H DUP7

Facility

$2,000.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,940.00
Rate for Payer: AlohaCare Medicaid	$1,000.00
Rate for Payer: AlohaCare Medicare	$1,520.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Devoted Health Medicare	$1,680.00
Rate for Payer: Hawaii Medical Service Association Medicare	$1,520.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,400.00
Rate for Payer: Health Management Network Commercial	$1,700.00
Rate for Payer: Humana Medicare	$1,520.00
Rate for Payer: Kaiser Permanente Commercial	$1,800.00
Rate for Payer: Kaiser Permanente Medicaid	$1,020.00
Rate for Payer: Kaiser Permanente Medicare	$1,520.00
Rate for Payer: MDX Hawaii PPO	$1,940.00
Rate for Payer: Ohana Health Plan Medicaid	$1,520.00
Rate for Payer: Ohana Health Plan Medicare	$1,520.00
Rate for Payer: UnitedHealthcare Medicare	$1,520.00
Rate for Payer: University Health Alliance Commercial	$1,120.00

PLATE DVR CROSLCK RT 131813050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR CROSLCK RT 131813050

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

PLATE DVR CROSSLCK R 131812040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR CROSSLCK R 131812040

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

PLATE DVR LF 131821040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR LF 131821040

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

PLATE DVR NARROW LF 131821050

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

PLATE DVR NARROW LF 131821050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR SHORT RT DVRANSR

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.50
Max. Negotiated Rate	$2,167.95
Rate for Payer: AlohaCare Medicaid	$1,117.50
Rate for Payer: AlohaCare Medicare	$1,698.60
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Devoted Health Medicare	$1,877.40
Rate for Payer: Hawaii Medical Service Association Medicare	$1,698.60
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Humana Medicare	$1,698.60
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: Kaiser Permanente Medicaid	$1,139.85
Rate for Payer: Kaiser Permanente Medicare	$1,698.60
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: Ohana Health Plan Medicaid	$1,698.60
Rate for Payer: Ohana Health Plan Medicare	$1,698.60
Rate for Payer: UnitedHealthcare Medicare	$1,698.60
Rate for Payer: University Health Alliance Commercial	$1,251.60

PLATE DVR SHORT RT DVRANSR

Facility

$2,235.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,251.60
Max. Negotiated Rate	$2,167.95
Rate for Payer: Cash Price	$1,341.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,564.50
Rate for Payer: Health Management Network Commercial	$1,899.75
Rate for Payer: Kaiser Permanente Commercial	$2,011.50
Rate for Payer: MDX Hawaii PPO	$2,167.95
Rate for Payer: University Health Alliance Commercial	$1,251.60

PLATE DVR XLCK LF 131822090

Facility

$5,160.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,580.00
Max. Negotiated Rate	$5,005.20
Rate for Payer: AlohaCare Medicaid	$2,580.00
Rate for Payer: AlohaCare Medicare	$3,921.60
Rate for Payer: Cash Price	$3,096.00
Rate for Payer: Devoted Health Medicare	$4,334.40
Rate for Payer: Hawaii Medical Service Association Medicare	$3,921.60
Rate for Payer: Hawaii Western Management Group Commercial	$3,612.00
Rate for Payer: Health Management Network Commercial	$4,386.00
Rate for Payer: Humana Medicare	$3,921.60
Rate for Payer: Kaiser Permanente Commercial	$4,644.00
Rate for Payer: Kaiser Permanente Medicaid	$2,631.60
Rate for Payer: Kaiser Permanente Medicare	$3,921.60
Rate for Payer: MDX Hawaii PPO	$5,005.20
Rate for Payer: Ohana Health Plan Medicaid	$3,921.60
Rate for Payer: Ohana Health Plan Medicare	$3,921.60
Rate for Payer: UnitedHealthcare Medicare	$3,921.60
Rate for Payer: University Health Alliance Commercial	$2,889.60

PLATE DVR XLCK LF 131822090

Facility

$5,160.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,889.60
Max. Negotiated Rate	$5,005.20
Rate for Payer: Cash Price	$3,096.00
Rate for Payer: Hawaii Western Management Group Commercial	$3,612.00
Rate for Payer: Health Management Network Commercial	$4,386.00
Rate for Payer: Kaiser Permanente Commercial	$4,644.00
Rate for Payer: MDX Hawaii PPO	$5,005.20
Rate for Payer: University Health Alliance Commercial	$2,889.60

PLATE DVR XLCK NARR 131811040

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE DVR XLCK NARR 131811040

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

PLATE DVR XLCK RT 131812050

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

PLATE DVR XLCK RT 131812050

Facility

$2,913.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,631.28
Max. Negotiated Rate	$2,825.61
Rate for Payer: Cash Price	$1,747.80
Rate for Payer: Hawaii Western Management Group Commercial	$2,039.10
Rate for Payer: Health Management Network Commercial	$2,476.05
Rate for Payer: Kaiser Permanente Commercial	$2,621.70
Rate for Payer: MDX Hawaii PPO	$2,825.61
Rate for Payer: University Health Alliance Commercial	$1,631.28

PLATE FEMORAL 627618

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,934.56
Max. Negotiated Rate	$6,815.22
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FEMORAL 627618

Facility

$7,026.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,513.00
Max. Negotiated Rate	$6,815.22
Rate for Payer: AlohaCare Medicaid	$3,513.00
Rate for Payer: AlohaCare Medicare	$5,339.76
Rate for Payer: Cash Price	$4,215.60
Rate for Payer: Devoted Health Medicare	$5,901.84
Rate for Payer: Hawaii Medical Service Association Medicare	$5,339.76
Rate for Payer: Hawaii Western Management Group Commercial	$4,918.20
Rate for Payer: Health Management Network Commercial	$5,972.10
Rate for Payer: Humana Medicare	$5,339.76
Rate for Payer: Kaiser Permanente Commercial	$6,323.40
Rate for Payer: Kaiser Permanente Medicaid	$3,583.26
Rate for Payer: Kaiser Permanente Medicare	$5,339.76
Rate for Payer: MDX Hawaii PPO	$6,815.22
Rate for Payer: Ohana Health Plan Medicaid	$5,339.76
Rate for Payer: Ohana Health Plan Medicare	$5,339.76
Rate for Payer: UnitedHealthcare Medicare	$5,339.76
Rate for Payer: University Health Alliance Commercial	$3,934.56

PLATE FEMORAL LF DISTAL 627604

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,318.00
Max. Negotiated Rate	$5,747.25
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMORAL LF DISTAL 627604

Facility

$5,925.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,962.50
Max. Negotiated Rate	$5,747.25
Rate for Payer: AlohaCare Medicaid	$2,962.50
Rate for Payer: AlohaCare Medicare	$4,503.00
Rate for Payer: Cash Price	$3,555.00
Rate for Payer: Devoted Health Medicare	$4,977.00
Rate for Payer: Hawaii Medical Service Association Medicare	$4,503.00
Rate for Payer: Hawaii Western Management Group Commercial	$4,147.50
Rate for Payer: Health Management Network Commercial	$5,036.25
Rate for Payer: Humana Medicare	$4,503.00
Rate for Payer: Kaiser Permanente Commercial	$5,332.50
Rate for Payer: Kaiser Permanente Medicaid	$3,021.75
Rate for Payer: Kaiser Permanente Medicare	$4,503.00
Rate for Payer: MDX Hawaii PPO	$5,747.25
Rate for Payer: Ohana Health Plan Medicaid	$4,503.00
Rate for Payer: Ohana Health Plan Medicare	$4,503.00
Rate for Payer: UnitedHealthcare Medicare	$4,503.00
Rate for Payer: University Health Alliance Commercial	$3,318.00

PLATE FEMORAL R DIS LAT 627640

Facility

$4,707.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$2,353.50
Max. Negotiated Rate	$4,565.79
Rate for Payer: AlohaCare Medicaid	$2,353.50
Rate for Payer: AlohaCare Medicare	$3,577.32
Rate for Payer: Cash Price	$2,824.20
Rate for Payer: Devoted Health Medicare	$3,953.88
Rate for Payer: Hawaii Medical Service Association Medicare	$3,577.32
Rate for Payer: Hawaii Western Management Group Commercial	$3,294.90
Rate for Payer: Health Management Network Commercial	$4,000.95
Rate for Payer: Humana Medicare	$3,577.32
Rate for Payer: Kaiser Permanente Commercial	$4,236.30
Rate for Payer: Kaiser Permanente Medicaid	$2,400.57
Rate for Payer: Kaiser Permanente Medicare	$3,577.32
Rate for Payer: MDX Hawaii PPO	$4,565.79
Rate for Payer: Ohana Health Plan Medicaid	$3,577.32
Rate for Payer: Ohana Health Plan Medicare	$3,577.32
Rate for Payer: UnitedHealthcare Medicare	$3,577.32
Rate for Payer: University Health Alliance Commercial	$2,635.92

Know your out-of-pocket cost for care.

All Charges